Provider Demographics
NPI:1053407049
Name:PARISI, MARK D (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:PARISI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8053 N KOLMAR
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:847-909-9858
Mailing Address - Fax:847-299-4952
Practice Address - Street 1:15 SPINNING WHEEL RD STE 30
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-7651
Practice Address - Country:US
Practice Address - Phone:847-909-9858
Practice Address - Fax:773-313-3320
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005598103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071-005598OtherSTATE LICENSE
IL593120Medicare PIN