Healthcare Provider Details

I. General information

NPI: 1891408092
Provider Name (Legal Business Name): CLINICAL FORENSIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E ERIE ST # 525-4535
CHICAGO IL
60611-2740
US

IV. Provider business mailing address

1 E ERIE ST # 525-4535
CHICAGO IL
60611-2740
US

V. Phone/Fax

Practice location:
  • Phone: 773-706-2815
  • Fax: 872-278-6660
Mailing address:
  • Phone: 773-706-2815
  • Fax: 872-278-6660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ZOE LEIBOWITZ
Title or Position: FOUNDER/PRINCIPAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 773-706-2815