Basic Information
| Provider Information | |||||||||
| NPI: | 1124772116 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH SHORE PSYCH SOLUTIONS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4711 GOLF RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127833348 | ||||||||
| FaxNumber: | 8476798340 | ||||||||
| Practice Location | |||||||||
| Address1: | 4711 GOLF RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127833348 | ||||||||
| FaxNumber: | 8476798340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2022 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | REES RILEY | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3127833348 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PSYCHOLOGIST | ||||||||
| NPICertificationDate: | 10/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.