| NPI | 1003221755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW PAUL RICHMOND Licensed Clinical Psychologist 847-421-0122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: IL 071008839) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IL 071008839) |
| 103TC0700X Psychologist, Clinical (Licence: IL 071008839) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 071008839) | |
| 103TF0000X Psychologist, Family (Licence: IL 071008839) | |
| 103TH0004X Psychologist, Health (Licence: IL 071008839) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: IL 071008839) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: IL 071008839) | |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2014-06-20 |