Provider Demographics
NPI:1144547571
Name:CHICAGOLAND PSYCHOLOGIST, LLC
Entity type:Organization
Organization Name:CHICAGOLAND PSYCHOLOGIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KARAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-203-2151
Mailing Address - Street 1:405 N WABASH AVE UNIT 4003
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5683
Mailing Address - Country:US
Mailing Address - Phone:312-203-2151
Mailing Address - Fax:630-789-1096
Practice Address - Street 1:405 N WABASH AVE UNIT 4003
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5683
Practice Address - Country:US
Practice Address - Phone:312-203-2151
Practice Address - Fax:630-789-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-25
Last Update Date:2010-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71006489103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty