Provider Demographics
NPI:1841244308
Name:HARWICKE, NEIL JAY (PHD)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:JAY
Last Name:HARWICKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 N. LAKE SHORE DRIVE
Mailing Address - Street 2:APT. 14F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2851
Mailing Address - Country:US
Mailing Address - Phone:773-425-9071
Mailing Address - Fax:
Practice Address - Street 1:800 MAIN ST. REFRESH IN-HOME-COUNSELING
Practice Address - Street 2:SUITE 210
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1578
Practice Address - Country:US
Practice Address - Phone:847-903-5604
Practice Address - Fax:224-788-5122
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003146103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL352550Medicare ID - Type Unspecified