Healthcare Provider Details

I. General information

NPI: 1710080676
Provider Name (Legal Business Name): SOL RAPPAPORT THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31480 HIGHWAY 45
LIBERTYVILLE IL
60045
US

IV. Provider business mailing address

31480 HIGHWAY 45
LIBERTYVILLE IL
60045
US

V. Phone/Fax

Practice location:
  • Phone: 847-680-2715
  • Fax: 847-680-3832
Mailing address:
  • Phone: 847-680-2715
  • Fax: 847-680-3832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: