Provider Demographics
NPI:1154776391
Name:PASTERNICKI, KATARZYNA PAULINA (PSYD, CADC)
Entity type:Individual
Prefix:MRS
First Name:KATARZYNA
Middle Name:PAULINA
Last Name:PASTERNICKI
Suffix:
Gender:F
Credentials:PSYD, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9448 BAY COLONY DR
Mailing Address - Street 2:APT 3N
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3647
Mailing Address - Country:US
Mailing Address - Phone:708-374-1928
Mailing Address - Fax:
Practice Address - Street 1:9448 BAY COLONY DR
Practice Address - Street 2:APT 3N
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-3647
Practice Address - Country:US
Practice Address - Phone:708-374-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL32307101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL32307OtherICB