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NPI Code Detail

MEDICARE: DR. TODD RUSSELL LENDVAY PSY.D.

MEDICARE: DR. TODD RUSSELL LENDVAY PSY.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
1103TC0700XClinical Psychologist071-07171IL
2101YP2500XProfessional Counselor180002906IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
104932629OTHERBLUE CROSS

General Provider Information

NPI Number : 1417010687
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TODD RUSSELL LENDVAY PSY.D.
Provider Business Mailing Address
First Line : 26112 W INDIAN TRAIL ROAD
Second Line :
City : BARRINGTON
State : IL
Zip : 60010
Country : US
Telephone Number : 847-997-2037
Fax Number : 847-776-4724
Provider Business Practice Location Address
First Line : 1644 W COLONIAL PKWY
Second Line :
City : INVERNESS
State : IL
Zip : 60067-1207
Country : US
Telephone Number : 847-997-2037
Fax Number : 847-776-4724
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2006
Last Update Date : 02/28/2014

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