Provider Demographics
NPI:1487728283
Name:MARK D PARISI PSY D & ASSOCIATES PC
Entity type:Organization
Organization Name:MARK D PARISI PSY D & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DOMINICK
Authorized Official - Last Name:PARISI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-909-9858
Mailing Address - Street 1:8053 KOLMAR AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3114
Mailing Address - Country:US
Mailing Address - Phone:847-909-9858
Mailing Address - Fax:847-299-4952
Practice Address - Street 1:800 E NORTHWEST HWY STE 106
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3457
Practice Address - Country:US
Practice Address - Phone:847-909-9858
Practice Address - Fax:847-299-4952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005598261QM0801X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1376730028Medicare UPIN
IL1053407049Medicare UPIN
IL209020Medicare PIN