Provider Demographics
NPI:1477046217
Name:ANTONOWICZ, EWA IRENE (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:EWA
Middle Name:IRENE
Last Name:ANTONOWICZ
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 W IRVING PARK RD APT A8
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3148
Mailing Address - Country:US
Mailing Address - Phone:773-655-6560
Mailing Address - Fax:
Practice Address - Street 1:332 S MICHIGAN AVE STE 1024
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-4483
Practice Address - Country:US
Practice Address - Phone:888-726-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004529103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist