Organization
SOUTH HAVEN BEHAVIORAL MODIFICATION II INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANTE PIMENTEL M.D. (PRESIDENT)
(773) 752-8602
Entity
Organization
Contact information
Practice address
448-454 E. 61ST ST, CHICAGO, IL 60637
(773) 752-8602
(773) 752-5824
Mailing address
4632 175TH PL, COUNTRY CLUB HILLS, IL 60478-4531
(708) 785-6597
(706) 206-0550
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
Primary
—
—
Other
Enumeration date
06/27/2006
Last updated
08/22/2020
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