Provider Demographics
NPI:1073361457
Name:CHERTOK, ROSANNA AMELIA (PSYD)
Entity type:Individual
Prefix:
First Name:ROSANNA
Middle Name:AMELIA
Last Name:CHERTOK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 W MONROE ST APT 502
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2458
Mailing Address - Country:US
Mailing Address - Phone:773-782-0711
Mailing Address - Fax:
Practice Address - Street 1:1414 S FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608
Practice Address - Country:US
Practice Address - Phone:773-565-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071011317103TH0004X, 103TC0700X
IN20043792B103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical