Provider Demographics
NPI:1316120785
Name:NORTH SHORE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:NORTH SHORE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEINSCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-412-1301
Mailing Address - Street 1:900 SKOKIE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4012
Mailing Address - Country:US
Mailing Address - Phone:847-412-1301
Mailing Address - Fax:847-412-1306
Practice Address - Street 1:900 SKOKIE BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4012
Practice Address - Country:US
Practice Address - Phone:847-412-1301
Practice Address - Fax:847-412-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-08
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636454OtherBCBS OF IL
ILK46317Medicare PIN
IL215768Medicare Oscar/Certification
IL214915Medicare Oscar/Certification