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General NPI Number Information
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NPI Number | 1184985970
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Entity Type | Individual
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Provider Name | LOU AGOSTA JR. PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | SHERIDAN ROAD
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City | CHICAGO
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State | IL
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Zip | 60660
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Country | US
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Telephone | 773-506-9511
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Fax |
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Provider Business Mailing Address
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Address Line | 5801 N SHERIDAN RD 8C
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City | CHICAGO
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State | IL
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Zip | 60660-3800
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Country | US
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Telephone | 773-203-0269
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number |
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License Number State |
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