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PCPA LEGACY LLC NPI 1093030132


NPI Information

NPI: 1093030132
Provider Name: PCPA LEGACY, LLC

Former Legal Business Name: PRIMARY CARE PSYCHOLOGY ASSOCAITES, LLC

Classification: Psychologist - 103TC0700X
Entity Type: Organization

Specialization: Clinical

Address:
400 SKOKIE BLVD STE 245
NORTHBROOK, IL
ZIP 60062
Phone: (847) 630-1611
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PCPA LEGACY, LLC is a clinical psychologist in Northbrook, IL. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. PCPA LEGACY, LLC NPI is 1093030132. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is Primary Care Psychology Assocaites, Llc.

The provider's business location address is:

400 SKOKIE BLVD STE 245
NORTHBROOK, IL
ZIP 60062-932
Phone: (847) 630-1611
Fax: (847) 446-4673

The provider's authorized official is Paul C Kredow .
The authorized official title is Provider/owner and has the following contact phone number (847) 630-1611.

The enumeration date for this NPI number is 4/1/2010 and was last updated on 9/6/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TC2200XPsychologistClinical Child & Adolescent071-004395ILLINOISNo
2103TC0700XPsychologistClinical071-004395ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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