Provider Demographics
NPI:1992716625
Name:PUSKARICH, CATHRYN A (PH D)
Entity type:Individual
Prefix:
First Name:CATHRYN
Middle Name:A
Last Name:PUSKARICH
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 OAKMONT PLAZA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5563
Mailing Address - Country:US
Mailing Address - Phone:630-850-2120
Mailing Address - Fax:630-850-2123
Practice Address - Street 1:999 OAKMONT PLAZA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5563
Practice Address - Country:US
Practice Address - Phone:630-850-2120
Practice Address - Fax:630-850-2123
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004490103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992716625Medicare UPIN