DR. BRADLEY C STOLBACH (NPI# 1114113487) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114113487 |
| Entity Type | Individual |
| Full Name | DR. BRADLEY C STOLBACH |
| Credential | PH.D. |
| Practice Address |
6700 S. Promontory Drive Chicago IL 60649 |
| Practice Telephone | 7732565735 |
| Mailing Telephone | 7732565735 |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2007-09-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
IL | Behavioral Health & Social Service Providers |
| Street Address |
6700 S. PROMONTORY DRIVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60649 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386250199 | A Safe Haven, L.L.C. | Clinic/Center | 7342-46 S Kingston, Chicago, IL 60649 | 2020-09-17 |
| 1477178713 | Angela K Coleman | Counselor | 1955 E 71st Street, Chicago, IL 60649 | 2020-06-12 |
| 1245880715 | Familydoc Urgent Care LLC | Clinic/Center | 7201 S Stony Island Ave, Chicago, IL 60649 | 2019-09-17 |
| 1912498668 | Venessel N/a Woodson I | Radiology | 7674 S. Southshore Dr #1n, Chicago, IL 60649 | 2018-05-29 |
| 1689117764 | Susana Jimenez | Occupational Therapy Assistant | 2649 E. 75th St, Chicago, IL 60649 | 2016-11-22 |
| 1063863579 | Regina Whittmon | Driver | 7808 S Coles Ave Apt 3, Chicago, IL 60649 | 2016-06-27 |
| 1174912356 | Montsho Gallardo | Doula | 7653 S Coles Ave, Chicago, IL 60649 | 2015-01-12 |
| 1780922120 | April Ong | Physical Therapist | 6700 S Oglesby Ave, Apt 1906, Chicago, IL 60649 | 2013-01-18 |
| 1114288594 | Days Adult Day Care and Personal Care Providers Inc | Clinic/Center | 2455 E 75th St, Chicago, IL 60649 | 2012-06-02 |
| 1891064887 | Kevin Forrest | Occupational Therapist | 2425 E. 71st Street, Chicago, IL 60649 | 2011-12-20 |
| Find all providers in zip 60649 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235647470 | Laurie Gayes Thompson | Psychologist | 225 E Chicago Ave # 2, Chicago, IL 60611-2991 | 2018-01-22 |
| 1558874891 | Claire Ashling Coyne | Psychologist | 225 E Chicago Ave # 10b, Chicago, IL 60611-2991 | 2017-11-08 |
| 1659721967 | Micah Ioffe | Psychologist | 1300 W Belmont Ave Ste 501, Chicago, IL 60657 | 2016-06-16 |
| 1609243856 | Humboldt Behavioral Health Group | Psychologist | 3317 W Le Moyne St, Chicago, IL 60651-2452 | 2015-08-24 |
| 1659610491 | Alexandra M Psihogios | Psychologist | 1110 W Columbia Ave, Apt 1n, Chicago, IL 60626-4522 | 2013-02-13 |
| 1265781934 | Anthony Thomas Vesco | Psychologist | 225 E Chicago Ave # 10a, Chicago, IL 60611-2991 | 2012-09-10 |
| 1689951519 | Jesse Klein | Psychologist | 639 W Diversey Pkwy Ste 207, Chicago, IL 60614-1535 | 2011-11-06 |
| 1639357486 | Victor J Bernstein | Psychologist | 2045 W Waveland Ave, Chicago, IL 60618-4949 | 2008-02-04 |
| 1023227469 | Thomas F. Barrett | Psychologist | 1030 N. Clark St., Suite 303, Chicago, IL 60610 | 2007-05-22 |
| 1316085954 | Carroll A Cradock | Psychologist | 411 S Sangamon St, Suite 2a, Chicago, IL 60607-3547 | 2007-02-04 |
| 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.