Provider Demographics
NPI:1588998678
Name:ASSOCIATES FOR EDUCATIONAL AND PSYCHOLOGICAL SERVICES, INC.
Entity type:Organization
Organization Name:ASSOCIATES FOR EDUCATIONAL AND PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:PISTORIO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-924-3951
Mailing Address - Street 1:1701 E LAKE AVE
Mailing Address - Street 2:SUITE 165
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2065
Mailing Address - Country:US
Mailing Address - Phone:847-924-3951
Mailing Address - Fax:
Practice Address - Street 1:1701 E LAKE AVE
Practice Address - Street 2:SUITE 165
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2065
Practice Address - Country:US
Practice Address - Phone:847-924-3951
Practice Address - Fax:847-998-6499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004038103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1922253848OtherNPI