Provider Demographics
NPI:1154462885
Name:SHOSHANA, YOSEF (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YOSEF
Middle Name:
Last Name:SHOSHANA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:MR
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:SHOSHANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1016 W JACKSON BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2914
Mailing Address - Country:US
Mailing Address - Phone:847-670-8544
Mailing Address - Fax:
Practice Address - Street 1:1016 W JACKSON BLVD STE 203
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2914
Practice Address - Country:US
Practice Address - Phone:847-670-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005603103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical