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General NPI Number Information
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NPI Number | 1649370214
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Entity Type | Organization
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Legal Business Name | EDMOND YOMTOOB, PSY.D., S.C.
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE STE 1005
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City | CHICAGO
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State | IL
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Zip | 60602-3750
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Country | US
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Telephone | 773-450-4434
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Fax |
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Provider Business Mailing Address
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Address Line | 8 S MICHIGAN AVE STE 2005
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City | CHICAGO
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State | IL
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Zip | 60603-3342
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Country | US
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Telephone | 773-450-4434
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Fax | 866-212-9520
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDMOND JACOB YOMTOOB
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Credential | PSY.D.
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Telephone | 773-450-4434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 072006350
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License Number State | IL
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