Provider Demographics
NPI:1417165242
Name:NUSSBAUM, KARIN MICHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KARIN
Middle Name:MICHELLE
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4452
Mailing Address - Country:US
Mailing Address - Phone:773-559-2245
Mailing Address - Fax:
Practice Address - Street 1:180 N MICHIGAN AVE STE 1820
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7415
Practice Address - Country:US
Practice Address - Phone:773-559-2245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007258103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical