Organization
CENTRAL PROFESSIONAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN BENEVIDES (BILLING SUPERVISOR)
(815) 725-6511
Entity
Organization
Contact information
Practice address
210 N HAMMES AVE, SUITE 103, JOLIET, IL 60435-6680
(815) 725-6511
(815) 725-7166
Mailing address
210 N HAMMES AVE, SUITE 103, JOLIET, IL 60435-6680
(815) 725-6511
(815) 725-7166
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467473462
—
IL
Enumeration date
04/04/2007
Last updated
04/28/2009
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