DR JOSEPH WALLACH PHD LLC (NPI# 1861758583) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861758583 |
| Entity Type | Organization |
| Organization Name | DR JOSEPH WALLACH PHD LLC |
| Practice Address |
4753 N Broadway St Suite 608 Chicago IL 60640-5266 |
| Mailing Address |
2741 W Greenleaf Ave Chicago IL 60645-3013 |
| Practice Telephone | 7738522400 |
| Practice Fax Number | 8478698116 |
| Mailing Telephone | 7738522400 |
| Mailing Fax Number | 8478698116 |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2012-04-06 |
| Authorized Official Name | DR. JOSEPH WALLACH (LICENSED CLINICAL PSYCHOLOGIST) |
| Authorized Official Telephone | 7738522400 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
071007942 | IL | Behavioral Health & Social Service Providers |
| N | 103TH0004X |
Psychologist Specialization: Health |
071007942 | IL | Behavioral Health & Social Service Providers |
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
071007942 | IL | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336415611 | Dr Joseph Wallach Phd LLC | Psychologist | 2530 Crawford Ave, Suite 304, Evanston, IL 60201-4970 | 2012-03-30 |
| Street Address |
4753 N BROADWAY ST SUITE 608 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60640-5266 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578560736 | Roberta Sue Barry | Social Worker | 4753 N Broadway St, Suite 928, Chicago, IL 60640-5266 | 2005-07-02 |
| 1538667084 | Kenan Pojskic | Clinic/Center | 4753 N Broadway St, Chicago, IL 60640-5266 | 2018-01-30 |
| 1033617865 | Kamran Naseem Malik | Clinic/Center | 4753 N Broadway St, Chicago, IL 60640-5266 | 2018-01-26 |
| 1912405895 | Hrishikesh T Shetty | Clinic/Center | 4753 N Broadway St, Chicago, IL 60640-5266 | 2018-01-25 |
| 1639614209 | Joanne Kardell | Social Worker | 4753 N Broadway St, 826, Chicago, IL 60640-5266 | 2017-01-05 |
| 1376997379 | Sachiko Kawata | Social Worker | 4753 N Broadway St, Suite #925, Chicago, IL 60640-5266 | 2016-04-16 |
| 1619321692 | Jennifer Annen | Counselor | 4753 N Broadway St, Suite 826, Chicago, IL 60640-5266 | 2016-04-15 |
| 1619355542 | Mcdermott Center | Substance Abuse Rehabilitation Facility | 4753 N Broadway St, Suite 612, Chicago, IL 60640-5266 | 2015-05-12 |
| 1225434236 | Joanna Vergoth | Social Worker | 4753 N Broadway St, Suite 509, Chicago, IL 60640-5266 | 2014-11-18 |
| 1548662257 | Daniel N Danforth | Acupuncturist | 4753 N Broadway St, Ste 810, Chicago, IL 60640-5266 | 2014-09-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336754233 | Rci (wrs), LLC. | Clinic/Center | 5221-23 North Broadway, Chicago, IL 60640 | 2020-09-09 |
| 1548871916 | Borici Counseling LLC | Counselor | 4731 N Paulina St, Chicago, IL 60640 | 2020-08-11 |
| 1306319173 | Gerardo Garcia | Physician Assistant | Medical Staff Office, Weiss Memorial Hospital, 4646 N Marine Drive, Chicago, IL 60640 | 2019-01-04 |
| 1386121283 | Aea Optical Ventures, LLC | Clinic/Center | 4814 N Clark St, Chicago, IL 60640 | 2018-07-24 |
| 1023503885 | Lauren Vassiliades | Internal Medicine | Weiss Memorial Hospital, Medical Education Dpt., 4646 N. Marine Drive, C Elevators, 7th Flr. # 7100, Chicago, IL 60640 | 2018-06-25 |
| 1477061620 | Yesenia Vargas | Nurse Practitioner | 1025 W Sunnyside, Chicago, IL 60640 | 2018-01-22 |
| 1932622206 | Jasleen Kaur Brar | Internal Medicine | 4646 N. Marine Dr., Chicago, IL 60640 | 2017-07-19 |
| 1750802849 | Umer Mukhtar | Internal Medicine | 4646 N. Marine Dr. Med Ed Dept. C Elevators., Weiss Memorial Hospital. 7 Floor. #7100, Chicago, IL 60640 | 2017-06-29 |
| 1184144081 | Ellie Navidson | Registered Nurse | 1015 W Lawrence, 2nd Floor, Chicago, IL 60640 | 2017-06-21 |
| 1962932558 | Jennifer Stridh | Marriage & Family Therapist | 5125 N. Winthrop Ave, 1f, Chicago, IL 60640 | 2017-06-15 |
| Find all providers in zip 60640 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821699166 | Jennifer Knuepfer, Psyd, Pllc | Psychologist | 4256 N Ravenswood Ave Ste 305, Chicago, IL 60613-1114 | 2020-11-03 |
| 1104426170 | Grace Giedgowd | Psychologist | 1640 W Division St Apt 205, Chicago, IL 60622-3939 | 2020-10-29 |
| 1184223364 | Caroline Elisabeth Fulton | Psychologist | 1739 N Elston Ave, Chicago, IL 60642-1544 | 2020-10-20 |
| 1881293108 | Haley Michelle Sims | Psychologist | 65 E Wacker Pl Ste 300, Chicago, IL 60601-7203 | 2020-10-19 |
| 1285231936 | Qianhui Zhang | Psychologist | 1225 W Morse Ave Apt 403, Chicago, IL 60626-5751 | 2020-10-06 |
| 1316544158 | Nancy Marie Picard | Psychologist | 4885 N Hermitage Ave, Chicago, IL 60640-4104 | 2020-10-05 |
| 1730792151 | Jenny Marie Wamsat | Psychologist | 1921 W Diversey Pkwy Apt 402, Chicago, IL 60614-9412 | 2020-08-25 |
| 1497365910 | Sara Sirota | Psychologist | 5443 N Broadway St # 2s, Chicago, IL 60640-1703 | 2020-08-10 |
| 1053920512 | Alyse Renae Bedell | Psychologist | 5841 S Maryland Ave Ste 300, Chicago, IL 60637-1443 | 2020-07-30 |
| 1699392688 | Hongying Chen | Psychologist | 720 W Sheridan Rd Apt 3s, Chicago, IL 60613-3252 | 2020-06-25 |
| Find all providers in CHICAGO | ||||
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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.