| NPI | 1215917109 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD FAJARDO Clinical Psychologist 773-388-8909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-006236) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2020-08-22 |