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NPI Code Detail

MEDICARE: VICTORIA LASSER, PH.D., P.C.

MEDICARE: VICTORIA LASSER, PH.D., P.C.
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
1103T00000XPsychologist0600007464IL

General Provider Information

NPI Number : 1679719439
Entity Type Code : Organization
Provider Name (Legal Business Name) : VICTORIA LASSER, PH.D., P.C.
Provider Business Mailing Address
First Line : 545 PARK AVE
Second Line :
City : GLENCOE
State : IL
Zip : 60022-1501
Country : US
Telephone Number : 312-595-9755
Fax Number :
Provider Business Practice Location Address
First Line : 480 N MCCLURG CT APT 513
Second Line :
City : CHICAGO
State : IL
Zip : 60611-5337
Country : US
Telephone Number : 312-595-9755
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. VICTORIA LASSER
Credential : PH.D.
Telephone Number : 312-595-9755
Provider Enumeration Date : 12/29/2008
Last Update Date : 12/29/2008

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