Organization
PSYCHODYNAMICS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALETA R. EDWARDS PSY.D. (PRESIDENT)
(847) 604-4626
Entity
Organization
Contact information
Practice address
3118 N SHEFFIELD AVE, UNIT 1-S, CHICAGO, IL 60657-8680
(847) 604-4626
Mailing address
3118 N SHEFFIELD AVE, UNIT 1-S, CHICAGO, IL 60657-8680
(847) 604-4626
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071004760
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001626993
BCBSIL PROVIDER ID
IL
Enumeration date
11/05/2006
Last updated
07/22/2008
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