Provider Demographics
NPI:1164402798
Name:BOLNICK, RICHARD NEAL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:NEAL
Last Name:BOLNICK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 LAKEVIEW PKWY
Mailing Address - Street 2:STE 110
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1400
Mailing Address - Country:US
Mailing Address - Phone:847-549-6650
Mailing Address - Fax:847-549-7005
Practice Address - Street 1:977 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1400
Practice Address - Country:US
Practice Address - Phone:847-549-6650
Practice Address - Fax:847-549-7005
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-003331103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4205873OtherAETNA PIN #
IL4932066OtherBC/BS PROVIDER #
IL459034000OtherMAGELLAN MIS #
IL459034000OtherMAGELLAN MIS #
IL202564Medicare PIN