Provider Demographics
NPI:1083808448
Name:ROBERT R. FELDMAN, PH.D. LTD.
Entity Type:Organization
Organization Name:ROBERT R. FELDMAN, PH.D. LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-601-3192
Mailing Address - Street 1:3163 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1144
Mailing Address - Country:US
Mailing Address - Phone:847-601-3192
Mailing Address - Fax:847-412-0756
Practice Address - Street 1:444 W FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3009
Practice Address - Country:US
Practice Address - Phone:847-601-3192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001607224OtherBC/BS PROVIDER NUMBER
IL0001607224OtherBC/BS PROVIDER NUMBER