Organization
PSYCHOLOGICAL RESOURCE CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK IRA BORNSTEIN PSYD (OWNER PRESIDENT)
(708) 461-2333
Entity
Organization
Contact information
Practice address
175 OLDE HALF DAY RD, SUITE 140-2, LINCOLNSHIRE, IL 60069-3061
(708) 461-2333
(773) 751-2250
Mailing address
46 CUMBERLAND DR, LINCOLNSHIRE, IL 60069
(708) 461-2333
(847) 267-8015
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071004534
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4932021
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/31/2006
Last updated
10/06/2009
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