Healthcare Provider Details

I. General information

NPI: 1730287210
Provider Name (Legal Business Name): RICHARD ANTHONY NIOLON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N DEARBORN ST SUITE 1012
CHICAGO IL
60610-4900
US

IV. Provider business mailing address

5455 N SHERIDAN RD #3708
CHICAGO IL
60640-1958
US

V. Phone/Fax

Practice location:
  • Phone: 773-507-6054
  • Fax:
Mailing address:
  • Phone: 773-561-1525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: