Provider Demographics
NPI:1649539560
Name:GERDOV, LIANA (PSY D)
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:
Last Name:GERDOV
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 WENTWORTH CIR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-2321
Mailing Address - Country:US
Mailing Address - Phone:630-988-5364
Mailing Address - Fax:630-216-1126
Practice Address - Street 1:1240 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-1897
Practice Address - Country:US
Practice Address - Phone:773-592-7227
Practice Address - Fax:630-216-1126
Is Sole Proprietor?:No
Enumeration Date:2012-05-12
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010496103TC0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health