Provider Demographics
NPI:1912092057
Name:CONTORER, BETTY RAYE
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:RAYE
Last Name:CONTORER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 W WILSON AVE
Mailing Address - Street 2:SUITE 6115
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5259
Mailing Address - Country:US
Mailing Address - Phone:773-561-0022
Mailing Address - Fax:773-561-1208
Practice Address - Street 1:1945 W WILSON AVE
Practice Address - Street 2:SUITE 6115
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5259
Practice Address - Country:US
Practice Address - Phone:773-561-0022
Practice Address - Fax:773-561-1208
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004430103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical