Healthcare Provider Details

I. General information

NPI: 1447538160
Provider Name (Legal Business Name): NEW DAY PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 ROGER WILLIAMS AVE #22
HIGHLAND PARK IL
60035-4823
US

IV. Provider business mailing address

580 ROGER WILLIAMS AVE #22
HIGHLAND PARK IL
60035-4823
US

V. Phone/Fax

Practice location:
  • Phone: 847-980-8707
  • Fax:
Mailing address:
  • Phone: 847-980-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007907
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number071007907
License Number StateIL

VIII. Authorized Official

Name: DR. VERED DOR
Title or Position: OWNER
Credential:
Phone: 847-980-8707