Provider Demographics
NPI:1649370214
Name:EDMOND YOMTOOB, PSY.D., S.C.
Entity type:Organization
Organization Name:EDMOND YOMTOOB, PSY.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:YOMTOOB
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-450-4434
Mailing Address - Street 1:8 S MICHIGAN AVE STE 2005
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3342
Mailing Address - Country:US
Mailing Address - Phone:773-450-4434
Mailing Address - Fax:866-212-9520
Practice Address - Street 1:30 N MICHIGAN AVE STE 1005
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3750
Practice Address - Country:US
Practice Address - Phone:773-450-4434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-24
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL072006350103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632882OtherBCBS
IL101305461829OtherHUMANA CORPHEALTH
IL205017571OtherCORPHEALTHHUMANA
IL533645OtherVALUE OPTIONS
IL9368304OtherPHCS