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General NPI Number Information
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NPI Number | 1285182121
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Entity Type | Organization
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Legal Business Name | DIANE M HERBSTMAN WELBEL PSYD LLC
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 3139 N LINCOLN AVE SUITE 203
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City | CHICAGO
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State | IL
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Zip | 60657-3114
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Country | US
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Telephone | 847-571-7726
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Fax |
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Provider Business Mailing Address
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Address Line | 1412 W WRIGHTWOOD AVE UNIT G
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City | CHICAGO
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State | IL
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Zip | 60614-1195
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Country | US
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Telephone | 847-571-7726
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. DIANE M WELBEL
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Credential | PSY.D.
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Telephone | 847-571-7726
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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 | 071008625
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License Number State | IL
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