Provider Demographics
NPI:1336278209
Name:TORTORIELLO, KENNETH F (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:F
Last Name:TORTORIELLO
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 1:233 E ERIE ST
Mailing Address - Street 2:SUITE 808
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2906
Mailing Address - Country:US
Mailing Address - Phone:312-649-1077
Mailing Address - Fax:847-835-8032
Practice Address - Street 1:233 E ERIE ST
Practice Address - Street 2:SUITE 808
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2906
Practice Address - Country:US
Practice Address - Phone:312-649-1077
Practice Address - Fax:847-835-8032
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
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
IL678260Medicare ID - Type Unspecified