Healthcare Provider Details

I. General information

NPI: 1659228922
Provider Name (Legal Business Name): DOMCZEWSKI BEHAVIORAL MEDICINE AND CONSULTATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2026
Last Update Date: 03/14/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5877 S BRADLEY CT
HANOVER PARK IL
60133-5207
US

IV. Provider business mailing address

5877 S BRADLEY CT
HANOVER PARK IL
60133-5207
US

V. Phone/Fax

Practice location:
  • Phone: 224-500-0153
  • Fax:
Mailing address:
  • Phone: 224-500-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. OLIVIA DOMCZEWSKI
Title or Position: OWNER, CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 224-500-0153