Provider Demographics
NPI:1891984217
Name:SYCAMORE PSYCHIATRY SC
Entity Type:Organization
Organization Name:SYCAMORE PSYCHIATRY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PLAUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-754-7500
Mailing Address - Street 1:2535 BETHANY RD
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3126
Mailing Address - Country:US
Mailing Address - Phone:815-754-7500
Mailing Address - Fax:815-754-0400
Practice Address - Street 1:2535 BETHANY RD
Practice Address - Street 2:SUITE 201B
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3126
Practice Address - Country:US
Practice Address - Phone:815-754-7500
Practice Address - Fax:815-754-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty