Provider Demographics
NPI:1528783321
Name:CRETE-MONEE SCHOOL DISTRICT 201U
Entity type:Organization
Organization Name:CRETE-MONEE SCHOOL DISTRICT 201U
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ADAMANTIA
Authorized Official - Middle Name:DINA
Authorized Official - Last Name:LEFTAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MEDEDS
Authorized Official - Phone:708-367-8355
Mailing Address - Street 1:1500 S SANGAMON ST
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-2831
Mailing Address - Country:US
Mailing Address - Phone:708-367-8355
Mailing Address - Fax:
Practice Address - Street 1:1500 S SANGAMON ST
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-2831
Practice Address - Country:US
Practice Address - Phone:708-367-8355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL62Medicaid