Healthcare Provider Details

I. General information

NPI: 1710179288
Provider Name (Legal Business Name): THOMAS J CAHILL PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 12/13/2018
Certification Date:
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 TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number0712048
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0712048
License Number StateIL

VIII. Authorized Official

Name: THOMAS J CAHILL
Title or Position: PRES.PSYCHOLOGIST
Credential: PHD
Phone: 708-245-8940