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General NPI Number Information
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NPI Number | 1881556603
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Entity Type | Organization
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Legal Business Name | OSTARA PSYCHOTHERAPY ASSOCIATES
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 400 CENTRAL AVE STE 250
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City | NORTHFIELD
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State | IL
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Zip | 60093-3024
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Country | US
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Telephone | 224-515-0556
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Fax |
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Provider Business Mailing Address
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Address Line | 2420 PALAZZO DR
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-4675
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Country | US
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Telephone | 224-515-0556
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED CLINICAL PSYCHOLOGIS
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Name | DR. BRENDA L. DANIELSON
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Credential | PSY.D.
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Telephone | 224-515-0556
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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 |
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License Number State |
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