Provider Demographics
NPI:1750882239
Name:COGNIZANT PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:COGNIZANT PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARCIA-LEAHY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:224-424-3087
Mailing Address - Street 1:507 QUASSEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1601
Mailing Address - Country:US
Mailing Address - Phone:312-399-5027
Mailing Address - Fax:
Practice Address - Street 1:51 SHERWOOD TER STE W
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2232
Practice Address - Country:US
Practice Address - Phone:224-424-3087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.006516103G00000X
IL071.008275103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty