| Psychology Connection Of North Shore, Llc | |
|
176 Acorn Ln Libertyville IL 60048-2158 | |
| (847) 630-9403 | |
| Not Available |
| Full Name | Psychology Connection Of North Shore, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 176 Acorn Ln, Libertyville, Illinois |
| Authorized Official Name and Position | Dorota Domanski-erdman (OWNER; PSYD) |
| Authorized Official Contact | 8476309403 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychology Connection Of North Shore, Llc 1665 Sherwood Rd Highland Park IL 60035-2260 Ph: (847) 630-9403 | Psychology Connection Of North Shore, Llc 176 Acorn Ln Libertyville IL 60048-2158 Ph: (847) 630-9403 |
| NPI Number | 1558974923 |
|---|---|
| Provider Enumeration Date | 08/26/2020 |
| Last Update Date | 12/13/2022 |
| Certification Date | 12/13/2022 |
| Medicare PECOS PAC ID | 0143640391 |
|---|---|
| Medicare Enrollment ID | O20201009000708 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558974923 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Dorota Jadwiga Domanski Erdman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033206636 PECOS PAC ID: 0749223139 Enrollment ID: I20050607000376 |
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