Healthcare Provider Details

I. General information

NPI: 1164117545
Provider Name (Legal Business Name): NOAH GELFMAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 SKOKIE BLVD
NORTHBROOK IL
60062-4013
US

IV. Provider business mailing address

4818 S DORCHESTER AVE APT 3
CHICAGO IL
60615-2027
US

V. Phone/Fax

Practice location:
  • Phone: 847-480-0300
  • Fax:
Mailing address:
  • Phone: 224-234-7285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.015273
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: