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General NPI Number Information
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NPI Number | 1154814713
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Entity Type | Organization
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Legal Business Name | NORTH SHORE PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 06/08/2018
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 2835 N SHEFFIELD AVE STE 402
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City | CHICAGO
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State | IL
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Zip | 60657-5084
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Country | US
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Telephone | 847-778-5533
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Fax | 833-325-1651
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Provider Business Mailing Address
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Address Line | 206 WHISTLER RD
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-5955
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Country | US
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Telephone | 847-323-8189
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Fax | 833-325-1651
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Authorized Official
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Title or Position | OWNER
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Name | JODY K ROTBLATT
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Credential | PSY.D.
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Telephone | 847-323-8189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149018766
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071008109
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License Number State | IL
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