Organization
PSYCHOTHERAPY AND ASSESSMENT OF HYDE PARK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THERESA GREGOIRE PSY.D. (MANAGING MEMBER)
(773) 771-8759
Entity
Organization
Contact information
Practice address
1525 E 55TH ST, SUITE 301B, CHICAGO, IL 60615-5512
(773) 771-8759
Mailing address
1525 E 55TH ST, SUITE 301B, CHICAGO, IL 60615-5512
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071007702
IL
1041C0700X
Clinical Social Worker
149.015492
IL
Other
Enumeration date
11/10/2014
Last updated
11/10/2014
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