Provider Demographics
NPI:1689864126
Name:JUSS, RAPHAEL A (EDD)
Entity Type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:A
Last Name:JUSS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N LAKE SHORE DRIVE
Mailing Address - Street 2:SUITE 13D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2193
Mailing Address - Country:US
Mailing Address - Phone:312-642-7785
Mailing Address - Fax:
Practice Address - Street 1:1300 N LAKE SHORE DRIVE
Practice Address - Street 2:SUITE 13D
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2193
Practice Address - Country:US
Practice Address - Phone:312-642-7785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC 365101YP2500X
10580103TS0200X
IL969747103TS0200X
1233025103TS0200X
TNLMT 145106H00000X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist