Organization
FORGE PSYCHOLOGY CHICAGO, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACKSON NEWSOME PSYD (LICENSED CLINICAL PSYCHOLOGIST)
(773) 683-3200
Entity
Organization
Contact information
Practice address
1331 N BOSWORTH AVE APT 3, CHICAGO, IL 60642-3421
(773) 683-3200
Mailing address
1331 N BOSWORTH AVE APT 3, CHICAGO, IL 60642-3421
(773) 683-3200
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
09/28/2023
Last updated
09/28/2023
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