Organization
LAKESHOREHEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAY SOBLE (SECRETARY)
(773) 286-0668
Entity
Organization
Contact information
Practice address
4444 W MONTROSE AVE, CHICAGO, IL 60641-2023
(773) 286-0668
(773) 286-0554
Mailing address
4444 W MONTROSE AVE, CHICAGO, IL 60641-2023
(773) 286-0668
(773) 286-0554
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
Primary
—
—
Other
Enumeration date
05/08/2006
Last updated
08/22/2020
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