SHORE THERAPY CENTER FOR WELLNESS, LLC (NPI# 1063067866) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063067866 |
| Entity Type | Organization |
| Organization Name | SHORE THERAPY CENTER FOR WELLNESS, LLC |
| Practice Address |
3330 Old Glenview Rd Ste 16 Wilmette IL 60091-2963 |
| Mailing Address |
1006 Marion Ave Highland Park IL 60035-5130 |
| Practice Telephone | 6303620129 |
| Mailing Telephone | 6303620129 |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2019-08-08 |
| Authorized Official Name | DR. CORRIE A GOLDBERG (LICENSED CLINICAL PSYCHOLOGIST) |
| Authorized Official Telephone | 6303620129 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
Behavioral Health & Social Service Providers | ||
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
Behavioral Health & Social Service Providers | ||
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers |
| Street Address |
3330 OLD GLENVIEW RD STE 16 |
| City | WILMETTE |
| State | IL |
| Zip Code | 60091-2963 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689284408 | Tanner Hoegh | Counselor | Address: 825 Green Bay Rd, Suite 200, Wilmette, IL 60091 | 2020-08-06 |
| 1205301082 | Charles Michael Falcone | Anesthesiology | 2743 Illinois Road, Wilmette, IL 60091 | 2018-10-09 |
| 1134646219 | Shari Beth Nivasch | Counselor | 445 Beverly Drive, Wilmette, IL 60091 | 2017-08-29 |
| 1508288440 | Debra Anne Brodd | Chiropractor | 522 Poplar, Wilmette, IL 60091 | 2014-01-13 |
| 1720411085 | Catherine Elizabeth Zwergel | Acupuncturist | 1215 Washington Ave Ste 203, Wilmette, IL 60091 | 2013-08-09 |
| 1447693106 | Michael Joseph Engelman | Dentist | 1625 Sheridan Rd. Suite M, Wilmette, IL 60091 | 2013-04-12 |
| 1720365117 | Anna Kielar | Pharmacist | 811 Greenbay Rd, Wilmette, IL 60091 | 2011-11-14 |
| 1306128368 | Victoriya Kharon | Pharmacist | 811 Greenbay Road, Wilmette, IL 60091 | 2011-09-15 |
| 1154626653 | Mary Jo Schmitz | Physical Therapist | 3330 Old Glenview Rd., Suite 4, Wilmette, IL 60091 | 2011-01-14 |
| 1053622522 | Stephanie Lynn Kutzen | Social Worker | 1925 Lake Avenue, Suite 305, Wilmette, IL 60091 | 2010-06-29 |
| Find all providers in zip 60091 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982190633 | Illuminate Psychological Assessments, LLC | Psychologist | 3330 Old Glenview Rd Ste 10, Wilmette, IL 60091-2963 | 2018-07-05 |
| 1316465412 | Linebarger & Associates, Ltd. | Psychologist | 1159 Wilmette Ave Ste 225, Wilmette, IL 60091-2653 | 2017-09-08 |
| 1235660317 | Pamela Rezek LLC | Psychologist | 819 Greenwood Ave, Wilmette, IL 60091-1749 | 2017-03-21 |
| 1205283793 | Diane Gruner Goodwin | Psychologist | 3330 Old Glenview Rd Ste 5, Wilmette, IL 60091-2963 | 2016-05-16 |
| 1104218627 | John Knapp | Psychologist | 400 Linden Ave Ste 2, Wilmette, IL 60091-2883 | 2015-02-19 |
| 1720485436 | Patricia Ann Lavallee | Psychologist | 1017 Central Ave, Wilmette, IL 60091-2609 | 2014-11-24 |
| 1649617069 | Susan London | Psychologist | 3223 Lake Ave, Suite # 15c-396, Wilmette, IL 60091-1069 | 2013-05-24 |
| 1841529187 | Anna Marie Buchmann | Psychologist | 2407 Iroquois Rd, Wilmette, IL 60091-1366 | 2009-12-16 |
| 1659581247 | Martin Howard Blackman | Psychologist | 207 3rd St, Wilmette, IL 60091-3440 | 2007-05-23 |
| 1316164619 | Paul D London | Psychologist | 1213 Forest Ave, Wilmette, IL 60091-1656 | 2007-04-19 |
| Find all providers in WILMETTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.