Provider Demographics
NPI:1538692561
Name:FOREMAN, CASEY (PSYD, MPH)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:PSYD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BARNARD LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5109
Mailing Address - Country:US
Mailing Address - Phone:248-229-1720
Mailing Address - Fax:
Practice Address - Street 1:1535 LAKE COOK RD STE 502
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1454
Practice Address - Country:US
Practice Address - Phone:248-229-1720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009695103TC0700X
IL071.009695103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical