Provider Demographics
NPI:1902935208
Name:DUARTE, REN F (PSYD)
Entity Type:Individual
Prefix:
First Name:REN
Middle Name:F
Last Name:DUARTE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N LAKE SHORE DR
Mailing Address - Street 2:APT. 1001
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3952
Mailing Address - Country:US
Mailing Address - Phone:773-348-9960
Mailing Address - Fax:
Practice Address - Street 1:3200 N LAKE SHORE DR
Practice Address - Street 2:APT. 1001
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1944
Practice Address - Country:US
Practice Address - Phone:773-348-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006715103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist