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NPI Code Detail

MEDICARE: COGNITVE SOLUTIONS LEARNING CENTER, INC.

MEDICARE: COGNITVE SOLUTIONS LEARNING CENTER, INC.
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
1103TS0200XSchool Psychologist
2103TC0700XClinical Psychologist071007252IL

General Provider Information

NPI Number : 1487899407
Entity Type Code : Organization
Provider Name (Legal Business Name) : COGNITVE SOLUTIONS LEARNING CENTER, INC.
Provider Business Mailing Address
First Line : 2409 N CLYBOURN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-6185
Country : US
Telephone Number : 773-755-1775
Fax Number : 773-439-5499
Provider Business Practice Location Address
First Line : 2409 N CLYBOURN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-6185
Country : US
Telephone Number : 773-755-1775
Fax Number : 773-439-5499
Authorized Official
Title or Position : DIRECTOR
Name : DR. ARI GOLDSTEIN
Credential : PH.D.
Telephone Number : 773-755-1775
Provider Enumeration Date : 12/04/2008
Last Update Date : 12/04/2008

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