Provider Demographics
NPI:1669704326
Name:ISAAC RAY CENTER AT CERMAK
Entity type:Organization
Organization Name:ISAAC RAY CENTER AT CERMAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KUSHNEREIT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:248-765-7127
Mailing Address - Street 1:3159 N SEMINARY AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3357
Mailing Address - Country:US
Mailing Address - Phone:248-765-7127
Mailing Address - Fax:
Practice Address - Street 1:3159 N SEMINARY #301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:248-765-7127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007792273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit