Provider Demographics
NPI:1477011310
Name:CENTER FOR INTEGRATIVE PSYCHIATRY LLC
Entity type:Organization
Organization Name:CENTER FOR INTEGRATIVE PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:MIETUS
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:224-361-3301
Mailing Address - Street 1:8745 W HIGGINS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2753
Mailing Address - Country:US
Mailing Address - Phone:224-361-3301
Mailing Address - Fax:405-337-9658
Practice Address - Street 1:8745 W HIGGINS RD STE 110
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-2753
Practice Address - Country:US
Practice Address - Phone:224-361-3301
Practice Address - Fax:405-337-9658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2023-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty