Healthcare Provider Details

I. General information

NPI: 1154814713
Provider Name (Legal Business Name): NORTH SHORE PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 N SHEFFIELD AVE STE 402
CHICAGO IL
60657-5084
US

IV. Provider business mailing address

206 WHISTLER RD
HIGHLAND PARK IL
60035-5955
US

V. Phone/Fax

Practice location:
  • Phone: 847-778-5533
  • Fax: 833-325-1651
Mailing address:
  • Phone: 847-323-8189
  • Fax: 833-325-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071008109
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149018766
License Number StateIL

VIII. Authorized Official

Name: JODY K ROTBLATT
Title or Position: OWNER
Credential: PSY.D.
Phone: 847-323-8189