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General NPI Number Information
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NPI Number | 1861907297
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Entity Type | Organization
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Legal Business Name | INBAR GREENFELD TAIRY PC
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 12/07/2017
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Provider Practice Location Address
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Address Line | 3000 DUNDEE RD STE 111
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City | NORTHBROOK
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State | IL
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Zip | 60062-2424
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Country | US
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Telephone | 708-560-6653
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Fax | 888-392-8402
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Provider Business Mailing Address
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Address Line | 3000 DUNDEE RD STE 111
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City | NORTHBROOK
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State | IL
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Zip | 60062-2424
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Country | US
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Telephone | 312-371-0252
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Fax |
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | LORI J NEWMAN
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Credential | BA CPC
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Telephone | 708-560-6653
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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 | 071009258
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License Number State | IL
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