Healthcare Provider Details

I. General information

NPI: 1689897639
Provider Name (Legal Business Name): DANIEL G MORJAL PSY.D, MSCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 N RAVENSWOOD AVE UNIT 320
CHICAGO IL
60640-4417
US

IV. Provider business mailing address

250 W DUNDEE RD UNIT 1002
WHEELING IL
60090-1235
US

V. Phone/Fax

Practice location:
  • Phone: 773-800-1513
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number374-000010
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number074-000010
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-007153
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: