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General NPI Number Information
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NPI Number | 1750882239
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Entity Type | Organization
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Legal Business Name | COGNIZANT PSYCHOLOGICAL SERVICES PLLC
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 51 SHERWOOD TER STE W
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City | LAKE BLUFF
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State | IL
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Zip | 60044-2232
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Country | US
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Telephone | 224-424-3087
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Fax |
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Provider Business Mailing Address
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Address Line | 507 QUASSEY AVE
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City | LAKE BLUFF
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State | IL
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Zip | 60044-1601
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Country | US
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Telephone | 312-399-5027
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Fax |
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Authorized Official
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Title or Position | OWNER AND CLINICAL PSYCHOLOGIST
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Name | CAROLINA M GARCIA-LEAHY
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Credential | PHD
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Telephone | 224-424-3087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 071.006516
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License Number State | IL
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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 | 071.008275
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License Number State | IL
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