Healthcare Provider Details

I. General information

NPI: 1780955815
Provider Name (Legal Business Name): LIFEWORKS PSYCHOTHERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8707 SKOKIE BLVD STE 216
SKOKIE IL
60077-2269
US

IV. Provider business mailing address

8707 SKOKIE BLVD STE 216
SKOKIE IL
60077-2269
US

V. Phone/Fax

Practice location:
  • Phone: 847-568-1100
  • Fax:
Mailing address:
  • Phone: 847-568-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-004558
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-006093
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number071-005305
License Number StateIL

VIII. Authorized Official

Name: DR. PATRICIA S COCHRAN
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 847-494-3650