Provider Demographics
NPI:1770662223
Name:SCHEINBAUM, SANDRA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LYNN
Last Name:SCHEINBAUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CENTRAL AVE
Mailing Address - Street 2:SUITE 144
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3211
Mailing Address - Country:US
Mailing Address - Phone:847-604-2752
Mailing Address - Fax:847-433-9190
Practice Address - Street 1:600 CENTRAL AVE
Practice Address - Street 2:SUITE 144
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3211
Practice Address - Country:US
Practice Address - Phone:847-604-2752
Practice Address - Fax:847-433-9190
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001670650OtherBLUE CROSS/BLUE SHIELD
IL999320Medicare ID - Type UnspecifiedLAKE COUNTY MEDICARE NUMB
IL999470Medicare ID - Type UnspecifiedCOOK COUNTY MEDICARE NUMB