Provider Demographics
NPI:1386618668
Name:SCHECTER, JERRY S (PHD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:S
Last Name:SCHECTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4532 S SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-7306
Mailing Address - Country:US
Mailing Address - Phone:847-679-5243
Mailing Address - Fax:847-753-9592
Practice Address - Street 1:9150 CRAWFORD AVE
Practice Address - Street 2:#105
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1700
Practice Address - Country:US
Practice Address - Phone:847-679-5243
Practice Address - Fax:847-753-9592
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1031731103TS0200X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1031731OtherSCHOOL TYPE 73 CERT.
ID0001672907OtherBLUE CROSS BLUE SHIELD
ID1031731OtherSCHOOL TYPE 73 CERT.