Healthcare Provider Details

I. General information

NPI: 1841244308
Provider Name (Legal Business Name): NEIL JAY HARWICKE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MAIN ST. REFRESH IN-HOME-COUNSELING SUITE 210
ANTIOCH IL
60002-1578
US

IV. Provider business mailing address

3440 N. LAKE SHORE DRIVE APT. 14F
CHICAGO IL
60657-2851
US

V. Phone/Fax

Practice location:
  • Phone: 847-903-5604
  • Fax: 224-788-5122
Mailing address:
  • Phone: 773-425-9071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071003146
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: