Organization
BROOK CLINIC ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD M. STEIN PH.D. (PRESIDENT)
(630) 571-1077
Entity
Organization
Contact information
Practice address
210 W 22ND ST, SUITE 118, OAK BROOK, IL 60523-1544
(630) 571-1077
Mailing address
210 W 22ND ST, SUITE 118, OAK BROOK, IL 60523-1544
(630) 571-1077
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
071-001939
IL
103TC0700X
Clinical Psychologist
Primary
071-001939
IL
103TH0100X
Health Service Psychologist
071-001939
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022-72048-74
BLUE CROSS/BLUE SHIELD
IL
01
—
071-001939
PSYCHOLOGIST REGISTRATION
IL
Enumeration date
12/04/2006
Last updated
11/13/2008
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