| Organization Name: | AERIES HEALTHCARE OF ILLINOIS PHYSICIAN GROUP |
| NPI Number: | 1083841076 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL NELSON (CFO) |
| Mailing Address: | 8311 W Roosevelt Rd Forest Park |
| State: | IL US |
| Postal Code: | 60130 |
| Phone Number: | 7082094150 |
| Fax Number: | |
| NPI Enumeration Date: | 06/17/2009 |
| NPI Last Update Date: | 06/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TP0016X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Prescribing (Medical) |
| Taxonomy Definition: | Those licensed psychologists who have completed specialized, post-doctoral training in psychopharmacology, passed a national proficiency examination in psychopharmacology, and who are authorized by state statute to prescribe medications, in accordance with their state law and state licensing authority, for the evaluation, diagnosis, management and treatment of mental, nervous, emotional, behavioral, and related disorders. |