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General NPI Number Information
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NPI Number | 1558769109
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Entity Type | Individual
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Provider Name | LORA VAN ARSDELL PSYD LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/15/2014
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 5 REVERE DR STE 200
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City | NORTHBROOK
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State | IL
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Zip | 60062-8000
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Country | US
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Telephone | 630-258-8059
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Fax | 844-629-5618
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Provider Business Mailing Address
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Address Line | 5 REVERE DRIVE, SUITE 200 PMD 2100
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City | NORTHBROOK
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State | IL
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Zip | 60062-1381
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Country | US
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Telephone | 630-258-8059
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Fax | 844-629-5618
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149017112
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071009542
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License Number State | IL
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