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General NPI Number Information
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NPI Number | 1033619911
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Entity Type | Organization
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Legal Business Name | CHICAGO DBT, LLC
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 3166 N LINCOLN AVE STE 214A
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City | CHICAGO
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State | IL
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Zip | 60657-3119
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Country | US
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Telephone | 503-908-4691
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Fax | 503-200-1146
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Provider Business Mailing Address
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Address Line | 3166 N LINCOLN AVE STE 214A
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City | CHICAGO
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State | IL
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Zip | 60657-3119
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Country | US
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Telephone | 503-908-4691
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Fax | 503-200-1146
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Authorized Official
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Title or Position | OWNER
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Name | DR. NICHOLAS JOHN SOTOR
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Credential | PSYD
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Telephone | 503-908-4691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.009608
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License Number State | IL
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