Provider Demographics
NPI:1609298702
Name:SMITH PSYCHOTHERAPY ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:SMITH PSYCHOTHERAPY ASSOCIATES, S.C.
Other - Org Name:ROBERT J. SMITH, LCSW
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-824-8366
Mailing Address - Street 1:419 LAUREN LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3519
Mailing Address - Country:US
Mailing Address - Phone:847-363-5845
Mailing Address - Fax:847-383-7753
Practice Address - Street 1:500 LAKE COOK RD STE 350
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5268
Practice Address - Country:US
Practice Address - Phone:847-363-5845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490000321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1114926235OtherNPI TYPE I
IL974590Medicare UPIN