MICHAEL J DIDOMENICO PSYD (NPI# 1417070152) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417070152 |
| Entity Type | Organization |
| Organization Name | MICHAEL J DIDOMENICO PSYD |
| Practice Address |
3545 Lake Ave Ste 100 Wilmette IL 60091-1058 |
| Mailing Address |
Po Box 443 Winnetka IL 60093-0443 |
| Practice Telephone | 8442511800 |
| Practice Fax Number | 8472511866 |
| Mailing Telephone | 8477706088 |
| Mailing Fax Number | 8475620202 |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2011-09-22 |
| Authorized Official Name | JANEEN BERRIOS (ACCOUNT MANAGER) |
| Authorized Official Telephone | 8477706088 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
071005762 | IL | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
071005762 | IL | Behavioral Health & Social Service Providers |
| Y | 103G00000X | Clinical Neuropsychologist | 071005762 | IL | Behavioral Health & Social Service Providers |
| Street Address |
3545 LAKE AVE STE 100 |
| City | WILMETTE |
| State | IL |
| Zip Code | 60091-1058 |
| 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 | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750307914 | Sally Jo Nador | Clinical Neuropsychologist | 1622 Wilmette Ave, Wilmette, IL 60091-2425 | 2006-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477183556 | Michelle Yvonne Kibby-faglier | Clinical Neuropsychologist | 285 Lake Indian Hills Dr, Carbondale, IL 62902-6184 | 2020-01-17 |
| 1003456708 | David Jackson | Clinical Neuropsychologist | 6 Parkway North Blvd, Deerfield, IL 60015-2522 | 2020-01-10 |
| 1649830159 | Natalie Berger | Clinical Neuropsychologist | 1645 W Jackson Blvd Ste 203, Chicago, IL 60612-3227 | 2019-06-17 |
| 1043877475 | Sarah Mailander Dyer | Clinical Neuropsychologist | 900 Royal Heights Rd Ste 14, Belleville, IL 62226-5457 | 2019-05-21 |
| 1639655632 | Julia Digangi | Clinical Neuropsychologist | 920 N York Rd, Hinsdale, IL 60521-2996 | 2018-07-13 |
| 1891211710 | Kenneth Vicencio | Clinical Neuropsychologist | 4100 Healthway Drive, Aurora, IL 60504 | 2017-08-22 |
| 1538690466 | Kathleen Ares | Clinical Neuropsychologist | 4440 W 95th, Suite 1200h, Oak Lawn, IL 60453 | 2017-03-22 |
| 1225575871 | Israel Gross | Clinical Neuropsychologist | 1934 W. Roscoe St., #4, Chicago, IL 60657 | 2017-01-20 |
| 1013462829 | Ann Westcot Jordan | Clinical Neuropsychologist | 21037 Benjamin Dr, Shorewood, IL 60404-0612 | 2016-08-22 |
| 1740638915 | Elizabeth Regina Tuminello Hartman | Clinical Neuropsychologist | 1875 Dempster St Ste 520, Park Ridge, IL 60068-1130 | 2016-05-29 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on MICHAEL J DIDOMENICO PSYD.
| 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.