Provider Demographics
NPI:1487175022
Name:BEHAVIORAL MEDICINE PARTNERS, LLC
Entity type:Organization
Organization Name:BEHAVIORAL MEDICINE PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-835-0315
Mailing Address - Street 1:135 S YORK ST UNIT 318
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3475
Mailing Address - Country:US
Mailing Address - Phone:617-835-0315
Mailing Address - Fax:
Practice Address - Street 1:28379 DAVIS PKWY STE 801
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3032
Practice Address - Country:US
Practice Address - Phone:630-393-9800
Practice Address - Fax:630-393-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009335103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty