Provider Demographics
NPI:1831321082
Name:DR. JEFFREY A. FISHBEIN, PSY.D, P.C
Entity Type:Organization
Organization Name:DR. JEFFREY A. FISHBEIN, PSY.D, P.C
Other - Org Name:DR. GAULT, FISHBEIN, AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FISHBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-267-0001
Mailing Address - Street 1:770 LAKE COOK RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4920
Mailing Address - Country:US
Mailing Address - Phone:847-267-0001
Mailing Address - Fax:847-267-0002
Practice Address - Street 1:770 LAKE COOK RD
Practice Address - Street 2:SUITE 250
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4920
Practice Address - Country:US
Practice Address - Phone:847-267-0001
Practice Address - Fax:847-267-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty