Healthcare Provider Details

I. General information

NPI: 1629123849
Provider Name (Legal Business Name): THOMAS JOSEPH CAHILL PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 COMMUNITY MEMORIAL DR
LA GRANGE IL
60525-2659
US

IV. Provider business mailing address

1325 COMMUNITY MEMORIAL DR
LA GRANGE IL
60525-2659
US

V. Phone/Fax

Practice location:
  • Phone: 708-245-8940
  • Fax: 708-245-5604
Mailing address:
  • Phone: 708-245-8940
  • Fax: 708-245-5604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0712048
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number0712048
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: