| Organization Name: | EDGEWOOD CLINICAL SERVICES OF PLAINFIELD |
| NPI Number: | 1043464803 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ADAM RUSSO (EXECUTIVE DIRECTOR) |
| Mailing Address: | 14722 S Naperville Rd Suite 112 Plainfield |
| State: | IL US |
| Postal Code: | 605443302 |
| Phone Number: | 6304287890 |
| Fax Number: | |
| NPI Enumeration Date: | 11/06/2008 |
| NPI Last Update Date: | 11/06/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 149010253 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |