Provider Demographics
NPI:1134801780
Name:MKP PSYCHOLOGY
Entity type:Organization
Organization Name:MKP PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MANASA
Authorized Official - Middle Name:K
Authorized Official - Last Name:PERERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-515-7841
Mailing Address - Street 1:820 SHANNON LAKE CT
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2593
Mailing Address - Country:US
Mailing Address - Phone:312-515-7841
Mailing Address - Fax:
Practice Address - Street 1:820 SHANNON LAKE CT
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-2593
Practice Address - Country:US
Practice Address - Phone:312-515-7841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty