Centrum Counseling & Phobia Clinic

Primary specialty

PsychologistTaxonomy code 103T00000X

License

I1071003499 Issued in IL

Legal business name

CENTRUM COUNSELING & PHOBIA CLINIC

Practice address

1101 Lake St
#201
Oak Park, IL 60301

Phone

(708) 386-7974

Fax

(708) 386-7977

NPI assigned

Feb 5, 2007

Last updated

Aug 22, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Marvin R Cohen, PSYDNPI 1134300718

Title

Psychologist President of Corp

Phone

(708) 386-7974

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marvin Richard Cohen, PSYD

  • Psychologist
  • Oak Park, IL
  • NPI 1134300718
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187740800000",
    "number": "1366581829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 LAKE ST",
            "address_2": "#201",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "60301",
            "telephone_number": "708-386-7974",
            "fax_number": "708-386-7977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 LAKE ST",
            "address_2": "#201",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "60301",
            "telephone_number": "708-386-7974",
            "fax_number": "708-386-7977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRUM COUNSELING & PHOBIA CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-08-22",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PSYCHOLOGIST PRESIDENT OF CORP",
        "authorized_official_telephone_number": "708-386-7974",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "I1071003499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nathaniel Cercavschi, PT, DPT, ATC
• Dalila Andrea Chacon
• Ariana Chaidez
• Gillian Chambers, LCSW
• Championz Korner PLLC (Championz Korner)

• Psychologist in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.