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General NPI Number Information
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NPI Number | 1417783655
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Entity Type | Individual
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Provider Name | SHEEBA DANIEL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 4905 OLD ORCHARD CTR STE 510
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City | SKOKIE
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State | IL
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Zip | 60077-4736
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Country | US
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Telephone | 847-484-1919
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Fax |
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Provider Business Mailing Address
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Address Line | 2433 W WARNER AVE
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City | CHICAGO
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State | IL
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Zip | 60618
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Country | US
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Telephone | 773-824-5816
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-006295
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License Number State | IL
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