Healthcare Provider Details

I. General information

NPI: 1831321082
Provider Name (Legal Business Name): DR. JEFFREY A. FISHBEIN, PSY.D, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 LAKE COOK RD SUITE 250
DEERFIELD IL
60015-4920
US

IV. Provider business mailing address

770 LAKE COOK RD SUITE 250
DEERFIELD IL
60015-4920
US

V. Phone/Fax

Practice location:
  • Phone: 847-267-0001
  • Fax: 847-267-0002
Mailing address:
  • Phone: 847-267-0001
  • Fax: 847-267-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY A FISHBEIN
Title or Position: PRESIDENT
Credential: PSY.D
Phone: 847-267-0001