Provider Demographics
NPI:1902815574
Name:NOONE, ROBERT J (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:NOONE
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 1:820 DAVIS ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4431
Mailing Address - Country:US
Mailing Address - Phone:847-507-3460
Mailing Address - Fax:
Practice Address - Street 1:820 DAVIS ST
Practice Address - Street 2:SUITE 504
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4431
Practice Address - Country:US
Practice Address - Phone:847-507-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490041661041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
991700Medicare ID - Type Unspecified