Provider Demographics
NPI:1407604291
Name:BEDROCK PSYCHOLOGY GROUP, PLLC
Entity type:Organization
Organization Name:BEDROCK PSYCHOLOGY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER / CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-389-2352
Mailing Address - Street 1:1063 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-2920
Mailing Address - Country:US
Mailing Address - Phone:773-575-0466
Mailing Address - Fax:
Practice Address - Street 1:1622 WILLOW RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3450
Practice Address - Country:US
Practice Address - Phone:773-389-2352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty