Provider Demographics
NPI:1598163008
Name:LOSOFF, PAUL (PSYD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:LOSOFF
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 WILLOW RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3450
Mailing Address - Country:US
Mailing Address - Phone:773-389-2352
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:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008946103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist