Provider Demographics
NPI:1598163008
Name:LOSOFF, PAUL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:LOSOFF
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 1:1011 W WELLINGTON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4325
Mailing Address - Country:US
Mailing Address - Phone:312-384-1940
Mailing Address - Fax:773-423-8444
Practice Address - Street 1:1011 W WELLINGTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4325
Practice Address - Country:US
Practice Address - Phone:312-384-1940
Practice Address - Fax:773-423-8444
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008946103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist