Healthcare Provider Details

I. General information

NPI: 1740215847
Provider Name (Legal Business Name): JOHN EDWARD NOTO JR. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8311 ROOSEVELT RD SUITE 100
FOREST PARK IL
60130-2529
US

IV. Provider business mailing address

3304 N BROADWAY ST SUITE 170
CHICAGO IL
60657-3517
US

V. Phone/Fax

Practice location:
  • Phone: 708-366-5555
  • Fax:
Mailing address:
  • Phone: 224-715-4542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: