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General NPI Number Information
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NPI Number | 1841244308
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Entity Type | Individual
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Provider Name | NEIL JAY HARWICKE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 800 MAIN ST. REFRESH IN-HOME-COUNSELING SUITE 210
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City | ANTIOCH
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State | IL
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Zip | 60002-1578
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Country | US
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Telephone | 847-903-5604
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Fax | 224-788-5122
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Provider Business Mailing Address
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Address Line | 3440 N. LAKE SHORE DRIVE APT. 14F
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City | CHICAGO
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State | IL
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Zip | 60657-2851
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Country | US
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Telephone | 773-425-9071
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071003146
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License Number State | IL
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