Provider Demographics
NPI:1295868834
Name:MACCHITELLI, FRANK J (PHD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:J
Last Name:MACCHITELLI
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 1:402 N WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2132
Mailing Address - Country:US
Mailing Address - Phone:630-543-0532
Mailing Address - Fax:
Practice Address - Street 1:120 OAKBROOK CTR
Practice Address - Street 2:SUITE 628
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1806
Practice Address - Country:US
Practice Address - Phone:630-572-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001673072BCBSOtherBCBS PROVIDER NUMBER
IL0001673072BCBSOtherBCBS PROVIDER NUMBER