Provider Demographics
NPI:1386744050
Name:HADESMAN, STEVEN M (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:HADESMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2540 SALCEDA DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7013
Mailing Address - Country:US
Mailing Address - Phone:312-816-4370
Mailing Address - Fax:312-236-7190
Practice Address - Street 1:55 E WASHINGTON ST
Practice Address - Street 2:SUITE 3305
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2103
Practice Address - Country:US
Practice Address - Phone:312-816-4370
Practice Address - Fax:312-236-7190
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212943Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST