Provider Demographics
NPI:1669650578
Name:SHELDON COTLER ET AL PTR NORTH SHORE CONSULTATION CENTER
Entity Type:Organization
Organization Name:SHELDON COTLER ET AL PTR NORTH SHORE CONSULTATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-498-4744
Mailing Address - Street 1:1535 LAKE COOK RD
Mailing Address - Street 2:SUITE #111
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1450
Mailing Address - Country:US
Mailing Address - Phone:847-498-4744
Mailing Address - Fax:847-498-4811
Practice Address - Street 1:1535 LAKE COOK RD
Practice Address - Street 2:SUITE #111
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1450
Practice Address - Country:US
Practice Address - Phone:847-498-4744
Practice Address - Fax:847-498-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty