Provider Demographics
NPI:1952551756
Name:RUSH NEUROBEHAVIORAL CENTER
Entity Type:Organization
Organization Name:RUSH NEUROBEHAVIORAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NEUROLOGIST / EXECUTIVE D
Authorized Official - Prefix:DR
Authorized Official - First Name:MERYL
Authorized Official - Middle Name:E
Authorized Official - Last Name:LIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:847-933-9339
Mailing Address - Street 1:4711 GOLF RD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1224
Mailing Address - Country:US
Mailing Address - Phone:847-933-9339
Mailing Address - Fax:847-933-0874
Practice Address - Street 1:4711 GOLF RD
Practice Address - Street 2:SUITE 1100
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1224
Practice Address - Country:US
Practice Address - Phone:847-933-9339
Practice Address - Fax:847-933-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079515261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health