| NPI | 1942759881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN RAMON HUMPHREY Psychologist/ Office Manager 708-232-3724 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IL 071000008646) |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2016-10-03 |