MEDICARE: DR. JONATHAN WEINBERG PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071-4149	IL

General Provider Information

NPI Number	:	1205051513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN WEINBERG PSY.D.

Provider Business Mailing Address
First Line	:	2405 N SHEFFIELD AVE
Second Line	:	P.O. BOX #1054
City	:	CHICAGO
State	:	IL
Zip	:	60614-8097
Country	:	US
Telephone Number	:	773-935-5912
Fax Number	:

Provider Business Practice Location Address
First Line	:	2518 N LINCOLN AVE
Second Line	:	#204
City	:	CHICAGO
State	:	IL
Zip	:	60614-2782
Country	:	US
Telephone Number	:	773-935-5912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	08/05/2014

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