Provider Demographics
NPI:1326210352
Name:YOMTOOB, EDMOND JACOB (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:JACOB
Last Name:YOMTOOB
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 1:30 N MICHIGAN AVE STE 1005
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3750
Mailing Address - Country:US
Mailing Address - Phone:773-450-4434
Mailing Address - Fax:
Practice Address - Street 1:8 S MICHIGAN AVE STE 2005
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3342
Practice Address - Country:US
Practice Address - Phone:773-450-4434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL072006350103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632882OtherBLUE CROSS