Provider Demographics
NPI:1407362189
Name:MOSK, MARK D (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:MOSK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 LOTUS PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1227
Mailing Address - Country:US
Mailing Address - Phone:847-652-6565
Mailing Address - Fax:
Practice Address - Street 1:3860 W NAUGHTON AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-1260
Practice Address - Country:US
Practice Address - Phone:650-999-0220
Practice Address - Fax:855-999-0220
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8865103T00000X
IL71006089103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist