Provider Demographics
NPI:1356792477
Name:REN F DUARTE PSY D INC
Entity type:Organization
Organization Name:REN F DUARTE PSY D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:REN
Authorized Official - Middle Name:F
Authorized Official - Last Name:DUARTE
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:773-315-0636
Mailing Address - Street 1:3200 N LAKE SHORE DR
Mailing Address - Street 2:APT. 1001
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3952
Mailing Address - Country:US
Mailing Address - Phone:773-315-0636
Mailing Address - Fax:
Practice Address - Street 1:3200 N LAKE SHORE DR
Practice Address - Street 2:APT. 1001
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3952
Practice Address - Country:US
Practice Address - Phone:773-315-0636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006715323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility