Kmetko & Associates, Ltd.
Clinic/Center (Adolescent and Children Mental Health)

Address: 4043 N Ravenswood Ave Ste 121, Chicago, IL 60613-1176
Phone: 7735616196

Kmetko & Associates, Ltd. (NPI# 1689296162) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1689296162
Entity Type Organization
Organization Name KMETKO & ASSOCIATES, LTD.
Practice Address 4043 N Ravenswood Ave Ste 121
IL 60613-1176
Practice Telephone 7735616196
Practice Fax Number 7736879812
Mailing Address 4043 N Ravenswood Ave Ste 121
IL 60613-1176
Mailing Telephone 7735616196
Mailing Fax Number 7736879812
Authorized Official Name Laurie Kaufman (INTERSTATE SERVICES SUPERVISOR)
Authorized Official Telephone 7735616196
Authorized Official Credential LCSW
Organization Subpart No, this organization is not a Subpart
Enumeration Date 2020-05-07
Last Update Date 2020-05-07

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 261QM0855X Clinic/Center · Adolescent and Children Mental Health Ambulatory Health Care Facilities

Taxonomy Information

Taxonomy Code 261QM0855X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Adolescent and Children Mental Health

Taxonomy Definition

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.
Notes: [7/1/2003: new]

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Office Location

Street Address 4043 N RAVENSWOOD AVE STE 121
State IL
Zip Code 60613-1176

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1760034128 Maryellen Karas Lajeunesse Social Worker 3930 N. Pine Grove Ave, #2403, Chicago, IL 60613 2019-07-15
1801366430 Stephanie A Dykema Psychologist 4043 N Ravenswood Ave Suite 302, Chicago, IL 60613 2018-11-27
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1972015782 Integrated Ortho, LLC. Durable Medical Equipment & Medical Supplies 3717 N. Ravenswood Ave, Suite 219w, Chicago, IL 60613 2017-11-02
1073048005 Claire Jolly Social Worker 3701 N Ravenswood Ave Ste 301, Chicago, IL 60613 2017-04-27
1730626011 Marc Fagan Psychologist 4101 N Ravenswood Ave., Chicago, IL 60613 2017-01-25
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1962955997 Michelle Montero Psychologist 925 W Dakin St Apt 405, Chicago, IL 60613 2016-07-26
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Zip Code 60613

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.