MEDICARE: DAVID B ALBERT PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071008659	IL

General Provider Information

NPI Number	:	1093775124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID B ALBERT PH.D.

Provider Business Mailing Address
First Line	:	1830 N HUDSON AVE UNIT A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-7978
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 N HUDSON AVE UNIT A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614
Country	:	US
Telephone Number	:	860-751-8076
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	12/14/2018

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