Provider Demographics
NPI:1104068626
Name:JUDITH LICHTENSTEIN, MD, S.C.
Entity type:Organization
Organization Name:JUDITH LICHTENSTEIN, MD, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:S
Authorized Official - Last Name:LICHTENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-944-1701
Mailing Address - Street 1:737 N MICHIGAN AVE
Mailing Address - Street 2:#2240
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2615
Mailing Address - Country:US
Mailing Address - Phone:312-944-1701
Mailing Address - Fax:312-944-0418
Practice Address - Street 1:737 N MICHIGAN AVE
Practice Address - Street 2:#2240
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2615
Practice Address - Country:US
Practice Address - Phone:312-944-1701
Practice Address - Fax:312-944-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36055048102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty