Healthcare Provider Details

I. General information

NPI: 1902993678
Provider Name (Legal Business Name): STEVAN EARL HOBFOLL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E WASHINGTON ST STE 1717
CHICAGO IL
60602-1839
US

IV. Provider business mailing address

1000 N LAKE SHORE PLZ APT 9B
CHICAGO IL
60611-1200
US

V. Phone/Fax

Practice location:
  • Phone: 312-436-0699
  • Fax:
Mailing address:
  • Phone: 312-643-0699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007543
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: