Provider Demographics
NPI:1811065121
Name:BROOK CLINIC ASSOCIATES, P.C.
Entity type:Organization
Organization Name:BROOK CLINIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-571-1077
Mailing Address - Street 1:210 W 22ND ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1544
Mailing Address - Country:US
Mailing Address - Phone:630-571-1077
Mailing Address - Fax:
Practice Address - Street 1:210 W 22ND ST
Practice Address - Street 2:SUITE 118
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1544
Practice Address - Country:US
Practice Address - Phone:630-571-1077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-001939103G00000X, 103TH0100X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071-001939OtherPSYCHOLOGIST REGISTRATION
IL022-72048-74OtherBLUE CROSS/BLUE SHIELD
IL071-001939OtherPSYCHOLOGIST REGISTRATION