Healthcare Provider Details

I. General information

NPI: 1225901234
Provider Name (Legal Business Name): CDPSYD L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3354 N PAULINA ST STE 202
CHICAGO IL
60657-1087
US

IV. Provider business mailing address

3354 N PAULINA ST STE 202
CHICAGO IL
60657-1087
US

V. Phone/Fax

Practice location:
  • Phone: 773-245-6358
  • Fax:
Mailing address:
  • Phone: 773-245-6358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY DOMENICO
Title or Position: OWNER/LICENSED PSYCHOLOGIST
Credential: PSY.D
Phone: 773-245-6358