Organization
MICHAEL J DIDOMENICO PSYD
Active
Organization
MICHAEL J DIDOMENICO PSYD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANEEN BERRIOS (ACCOUNT MANAGER)
(847) 770-6088
Entity
Organization
Contact information
Practice address
3545 LAKE AVE STE 100, WILMETTE, IL 60091-1058
(844) 251-1800
(847) 251-1866
Mailing address
PO BOX 443, WINNETKA, IL 60093-0443
(847) 770-6088
(847) 562-0202
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
071005762
IL
103TB0200X
Cognitive & Behavioral Psychologist
071005762
IL
103TC0700X
Clinical Psychologist
071005762
IL
Other
Enumeration date
04/09/2007
Last updated
09/22/2011
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