Provider Demographics
NPI:1245499979
Name:CHICAGO NORTHSHORE PSYCHOLOGISTS, INC.
Entity type:Organization
Organization Name:CHICAGO NORTHSHORE PSYCHOLOGISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIEFT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-259-7732
Mailing Address - Street 1:4905 OLD ORCHARD CTR
Mailing Address - Street 2:SUITE 607
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1458
Mailing Address - Country:US
Mailing Address - Phone:773-259-7732
Mailing Address - Fax:
Practice Address - Street 1:4905 OLD ORCHARD CTR
Practice Address - Street 2:SUITE 607
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1458
Practice Address - Country:US
Practice Address - Phone:773-259-7732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007068103TC2200X
IL071006758103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty