=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568173565
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SILVIA BOZZANO BECK, PH.D. PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2022
-----------------------------------------------------
Last Update Date | 03/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 REVERE DR STE 200
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-8000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-496-0040
-----------------------------------------------------
Fax | 847-610-6808
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 REVERE DR STE 200
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-8000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-496-0040
-----------------------------------------------------
Fax | 847-610-6808
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | SILVIA BOZZANO BECK
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 847-309-7641
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------