Di Domenico, Michael J

Di Domenico, Michael J is an sole proprietor health care provider with primary practice located at 707 Skokie Blvd Ste 600 , Northbrook IL 60062-2841. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Clinical Neuropsychologist. Behavioral Health & Social Service Providers / Clinical Neuropsychologist is his primary health care specialty. Di Domenico, Michael J can be contacted via phone (630) 632-0746.

Contact Information

Primary practice address
707 Skokie Blvd Ste 600 Northbrook IL 60062-2841
Phone: (630) 632-0746
Fax: (847) 272-8221
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 071055762 Illinois
Behavioral Health & Social Service Providers / Clinical 103TC0700X 071005762 Illinois
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X 071005762 Illinois

Profile Details

NPI number 1861442345
LBN Legal business name Di Domenico, Michael J
Credentials PSYD
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 12th, 2006
Last updated Jul 25th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861442345 NPPES
Illinois Other 1623280 BLUE CROSS BLUE SHIELD

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