Healthcare Provider Details

I. General information

NPI: 1487899407
Provider Name (Legal Business Name): COGNITVE SOLUTIONS LEARNING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 12/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 N CLYBOURN AVE
CHICAGO IL
60614-6185
US

IV. Provider business mailing address

2409 N CLYBOURN AVE
CHICAGO IL
60614-6185
US

V. Phone/Fax

Practice location:
  • Phone: 773-755-1775
  • Fax: 773-439-5499
Mailing address:
  • Phone: 773-755-1775
  • Fax: 773-439-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007252
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ARI GOLDSTEIN
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 773-755-1775