Provider Demographics
NPI:1811178163
Name:ASSOCIATES IN ADOLESCENT PSYCHIATRY SC
Entity type:Organization
Organization Name:ASSOCIATES IN ADOLESCENT PSYCHIATRY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHWARZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-290-8461
Mailing Address - Street 1:530 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1420
Mailing Address - Country:US
Mailing Address - Phone:630-290-8461
Mailing Address - Fax:847-835-0863
Practice Address - Street 1:530 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-1420
Practice Address - Country:US
Practice Address - Phone:630-290-8461
Practice Address - Fax:847-835-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty