Provider Demographics
NPI:1760367163
Name:INTERCONNECTIVITY PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:INTERCONNECTIVITY PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXA
Authorized Official - Middle Name:
Authorized Official - Last Name:KERAMIDAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-639-2368
Mailing Address - Street 1:2027 W DIVISION ST # 187
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-9024
Mailing Address - Country:US
Mailing Address - Phone:224-639-2368
Mailing Address - Fax:
Practice Address - Street 1:2731 W PRINDIVILLE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4028
Practice Address - Country:US
Practice Address - Phone:224-639-2368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty