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General NPI Number Information
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NPI Number | 1487899407
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Entity Type | Organization
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Legal Business Name | COGNITVE SOLUTIONS LEARNING CENTER, INC.
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Dates
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Enumeration Date | 12/04/2008
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | 2409 N CLYBOURN AVE
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City | CHICAGO
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State | IL
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Zip | 60614-6185
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Country | US
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Telephone | 773-755-1775
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Fax | 773-439-5499
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Provider Business Mailing Address
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Address Line | 2409 N CLYBOURN AVE
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City | CHICAGO
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State | IL
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Zip | 60614-6185
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Country | US
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Telephone | 773-755-1775
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Fax | 773-439-5499
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ARI GOLDSTEIN
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Credential | PH.D.
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Telephone | 773-755-1775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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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 | 071007252
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License Number State | IL
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