Healthcare Provider Details

I. General information

NPI: 1104068626
Provider Name (Legal Business Name): JUDITH LICHTENSTEIN, MD, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 N MICHIGAN AVE #2240
CHICAGO IL
60611-2615
US

IV. Provider business mailing address

737 N MICHIGAN AVE #2240
CHICAGO IL
60611-2615
US

V. Phone/Fax

Practice location:
  • Phone: 312-944-1701
  • Fax: 312-944-0418
Mailing address:
  • Phone: 312-944-1701
  • Fax: 312-944-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number36055048
License Number StateIL

VIII. Authorized Official

Name: DR. JUDITH S. LICHTENSTEIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 312-944-1701