MICHAEL J DI DOMENICO (NPI# 1861442345) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861442345 |
| Entity Type | Individual |
| Full Name | MICHAEL J DI DOMENICO |
| Credential | PSYD |
| Practice Address |
1535 Lake Cook Rd Suite 306 Northbrook IL 60062-1447 |
| Mailing Address |
Po Box 472 Northbrook IL 60065-0472 |
| Practice Telephone | 6306320746 |
| Practice Fax Number | 8472728221 |
| Mailing Telephone | 8475044060 |
| Mailing Fax Number | 8479198399 |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2017-01-19 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103G00000X | Clinical Neuropsychologist | 071005762 | IL | Behavioral Health & Social Service Providers |
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
071005762 | IL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS BLUE SHIELD | 1623280 | 01 |
| Street Address |
1535 LAKE COOK RD SUITE 306 |
| City | NORTHBROOK |
| State | IL |
| Zip Code | 60062-1447 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306849252 | Steven Neal Kacel | Dentist | 1535 Lake Cook Rd, Ste 107, Northbrook, IL 60062-1450 | 2005-05-24 |
| 1841736402 | Audrey Grunst Lcsw | Counselor | 1535 Lake Cook Rd, Sute 303, Northbrook, IL 60062-1447 | 2017-01-06 |
| 1801339684 | Anna Lynn Kreiser | Dietitian, Registered | 1535 Lake Cook Rd, Suite 303, Northbrook, IL 60062-1447 | 2016-11-28 |
| 1528476694 | Jennifer Mandell | Specialist | 1535 Lake Cook Rd, 112, Northbrook, IL 60062-1447 | 2014-08-01 |
| 1003248378 | Break4health | Health Maintenance Organization | 1535 Lake Cook Rd, #112, Northbrook, IL 60062-1447 | 2013-08-08 |
| 1629315288 | Monica Michelle Bullock | Counselor | 1535 Lake Cook Rd, Suite 303, Northbrook, IL 60062-1447 | 2013-01-15 |
| 1164768073 | Jill Perez | Counselor | 1535 Lake Cook Rd, Northbrook, IL 60062-1447 | 2012-12-20 |
| 1740540178 | Michael A. Epstein Md Sc | Specialist | 1535 Lake Cook Rd, Suite 211, Northbrook, IL 60062-1447 | 2012-05-18 |
| 1558629212 | David I. Rosen, M.d. Ltd | Internal Medicine | 1535 Lake Cook Rd, 401, Northbrook, IL 60062-1447 | 2012-05-01 |
| 1184934523 | Beth W. Ross | Counselor | 1535 Lake Cook Rd, Suite 111, Northbrook, IL 60062-1447 | 2010-10-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508487067 | Cvs Aoc Services, L.L.C. | Optometrist | 936 Willow Road, Store 0141, Northbrook, IL 60062 | 2020-05-06 |
| 1386103885 | Jennifer Venegas | Behavior Technician | 5 Revere Dr Suit 120, Northbrook, IL 60062 | 2019-03-14 |
| 1720558281 | Taylor Hundley | Behavior Technician | 5 Revere Dr. Suite 120, Northbrook, IL 60062 | 2018-11-27 |
| 1609344027 | Melissa Cepeda | Behavior Technician | 5 Revere Dr Suite 120, Northbrook, IL 60062 | 2018-11-03 |
| 1235606658 | Candace Cheyenne Kaiser | Behavior Technician | 5 Revere Dr, Suite 120, Northbrook, IL 60062 | 2018-10-24 |
| 1275058745 | The Renfrew Center of Illinois | Counselor | 5 Revere Dr, Suite 100, Northbrook, IL 60062 | 2017-08-07 |
| 1467984773 | Ayzenshteyn Chiropractic | Chiropractor | 3210 Doolittle Dr., Northbrook, IL 60062 | 2017-03-28 |
| 1396282695 | Josephine Driscoll | Physician Assistant | 400 Skokie Blvd., Suite 450, Northbrook, IL 60062 | 2017-01-24 |
| 1396297842 | Lauren Raphael Lcsw LLC | Social Worker | 3050 Pheasant Creek Drive, Apt. 104, Northbrook, IL 60062 | 2016-11-01 |
| 1851847073 | Jassim Vailoces | Physical Therapist | 634 Academy Dr, Northbrook, IL 60062 | 2016-08-28 |
| Find all providers in zip 60062 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083222491 | Michele Caroline Henhapl | Psychologist | 899 Skokie Blvd Ste 426, Northbrook, IL 60062-4024 | 2020-07-21 |
| 1881153096 | Janet K White | Psychologist | 601 Skokie Blvd Ste 300, Northbrook, IL 60062-2819 | 2019-03-18 |
| 1386108074 | Irina Beyderman | Psychologist | 4001 Bordeaux Dr, Northbrook, IL 60062-2139 | 2019-01-26 |
| 1811466063 | Kerry Pecho | Psychologist | 601 Skokie Blvd Ste 203, Northbrook, IL 60062-2818 | 2018-11-16 |
| 1831673862 | Kenneth Kikuchi | Psychologist | 601 Skokie Blvd Ste 402, Northbrook, IL 60062-2820 | 2018-09-14 |
| 1164933123 | Lucy Rickspoone | Psychologist | 3400 Dundee Rd # 105, Northbrook, IL 60062-2320 | 2017-10-18 |
| 1013442334 | Elie Saltzman | Psychologist | 666 Dundee Rd Ste 305, Northbrook, IL 60062-2726 | 2017-04-24 |
| 1538692561 | Casey Foreman | Psychologist | 1535 Lake Cook Rd Ste 502, Northbrook, IL 60062-1454 | 2017-04-06 |
| 1043682321 | Martine Gorstein | Psychologist | 601 Skokie Blvd., Suite 104, Northbrook, IL 60062 | 2015-10-26 |
| 1861869646 | Neal J Gordon Edd Sc | Psychologist | 4105 Rutgers Ln, Northbrook, IL 60062-2911 | 2015-08-27 |
| Find all providers in NORTHBROOK | ||||
| City | NORTHBROOK |
| Zip Code | 60062 |
Please comment or provide details below to improve the information on MICHAEL J DI DOMENICO.
| 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.