| North Shore Psychotherapy, Llc | |
|
2502 N Clark St Chicago IL 60614-1850 | |
| (847) 778-5533 | |
| Not Available |
| Full Name | North Shore Psychotherapy, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 2502 N Clark St, Chicago, Illinois |
| Authorized Official Name and Position | Jody K Rotblatt (OWNER) |
| Authorized Official Contact | 8473238189 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Shore Psychotherapy, Llc 615 Euclid Ct Highland Park IL 60035-1271 Ph: (847) 323-8189 | North Shore Psychotherapy, Llc 2502 N Clark St Chicago IL 60614-1850 Ph: (847) 778-5533 |
| NPI Number | 1154814713 |
|---|---|
| Provider Enumeration Date | 06/08/2018 |
| Last Update Date | 09/25/2018 |
| Medicare PECOS PAC ID | 8527498708 |
|---|---|
| Medicare Enrollment ID | O20200501001045 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154814713 | NPI | - | NPPES |
| 1982122412 | Other | IL | BCBS-IL |
| 1487872735 | Other | IL | BCBS-IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071008109 (Illinois) | Primary |
| 1041C0700X | Social Worker - Clinical | 149018766 (Illinois) | Secondary |
| Provider Name | Jody K Rotblatt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508083510 PECOS PAC ID: 5395902514 Enrollment ID: I20120131000214 |
| Provider Name | Alexis Schmiedigen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336457928 PECOS PAC ID: 7315329885 Enrollment ID: I20220729002503 |
| Provider Name | Gisele Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265636674 PECOS PAC ID: 5496131120 Enrollment ID: I20221004002851 |
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