Provider Demographics
NPI:1205988045
Name:WEISSMAN, HOWARD K (PSYD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:K
Last Name:WEISSMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 SKOKIE BLVD STE 430
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4024
Mailing Address - Country:US
Mailing Address - Phone:847-412-0922
Mailing Address - Fax:847-412-0756
Practice Address - Street 1:899 SKOKIE BLVD STE 430
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4024
Practice Address - Country:US
Practice Address - Phone:847-412-0922
Practice Address - Fax:847-412-0756
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004710103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001604762OtherBLUECROSS BLUE SHEILD
IL995390Medicare ID - Type UnspecifiedMEDICARE