Provider Demographics
NPI:1356664973
Name:LRS GROUP
Entity type:Organization
Organization Name:LRS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-383-0729
Mailing Address - Street 1:6601 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1005
Mailing Address - Country:US
Mailing Address - Phone:708-383-0729
Mailing Address - Fax:708-383-6729
Practice Address - Street 1:6601 NORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1005
Practice Address - Country:US
Practice Address - Phone:708-383-0729
Practice Address - Fax:708-383-6729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1490099821041C0700X
IL1490036101041C0700X
IL071006523103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty