Organization
JERRY PORZEMSKY, PH.D. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY MARVIN PORZEMSKY PH.D. (PRESIDENT)
(773) 262-5757
Entity
Organization
Contact information
Practice address
2909 W FARGO AVE, CHICAGO, IL 60645-1222
(773) 262-5757
(773) 262-4018
Mailing address
2909 W FARGO AVE, CHICAGO, IL 60645-1222
(773) 262-5757
(773) 262-4018
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071001197
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01672054
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/21/2010
Last updated
06/24/2010
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