Provider Demographics
NPI:1922013390
Name:GORECKI, PAUL R (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:GORECKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S NORTHWEST HWY
Mailing Address - Street 2:#201
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4652
Mailing Address - Country:US
Mailing Address - Phone:847-382-2449
Mailing Address - Fax:847-382-9718
Practice Address - Street 1:800 S NORTHWEST HWY
Practice Address - Street 2:#201
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-4652
Practice Address - Country:US
Practice Address - Phone:847-382-2449
Practice Address - Fax:847-382-9718
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-002828103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical