Provider Demographics
NPI:1952553414
Name:EUGENIE B. PABST, LLC
Entity type:Organization
Organization Name:EUGENIE B. PABST, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:PABST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-472-0560
Mailing Address - Street 1:1901 N CLYBOURN AVE
Mailing Address - Street 2:301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5090
Mailing Address - Country:US
Mailing Address - Phone:773-472-0560
Mailing Address - Fax:
Practice Address - Street 1:1901 N CLYBOURN AVE
Practice Address - Street 2:301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5090
Practice Address - Country:US
Practice Address - Phone:773-472-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty