Provider Demographics
NPI:1417425182
Name:CENTER FOR PSYCHODYNAMIC PSYCHOTHERAPY, INC.
Entity Type:Organization
Organization Name:CENTER FOR PSYCHODYNAMIC PSYCHOTHERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CORTNEY
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-906-4303
Mailing Address - Street 1:400 LINDEN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2883
Mailing Address - Country:US
Mailing Address - Phone:847-906-4303
Mailing Address - Fax:
Practice Address - Street 1:400 LINDEN AVE STE 2
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2883
Practice Address - Country:US
Practice Address - Phone:847-906-4303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-11
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty