Provider Demographics
NPI:1578568622
Name:LINDEN, PAUL DALE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DALE
Last Name:LINDEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N WABASH AVE
Mailing Address - Street 2:STE 1408
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3075
Mailing Address - Country:US
Mailing Address - Phone:312-499-6873
Mailing Address - Fax:312-443-1307
Practice Address - Street 1:111 N WABASH AVE
Practice Address - Street 2:STE 1408
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3075
Practice Address - Country:US
Practice Address - Phone:312-499-6873
Practice Address - Fax:312-443-1307
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004780103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL630000Medicare ID - Type Unspecified