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Organization
PEDIATRIC DEVELOPMENTAL CENTER
Active
Organization
PEDIATRIC DEVELOPMENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VALERIA NANCLARES PSY.D. (COORDINATOR OF AMG AUTISM PROGRAM)
(773) 296-5854
Entity
Organization
Contact information
Practice address
552 W BRIAR PL APT 1E, CHICAGO, IL 60657-4697
(858) 336-1480
Mailing address
552 W BRIAR PL APT 1E, CHICAGO, IL 60657-4697
(858) 336-1480
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/17/2015
Last updated
03/17/2015
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