NPIMap

Organization Active NPI

Lincoln Park Psychology, Inc.

  • Psychologist
  • Chicago, IL
National Provider Identifier
1013524818
Registry record updated Oct 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
LINCOLN PARK PSYCHOLOGY, INC.
Practice address
644 W Webster Ave # B
Chicago, IL 60614-3710
Phone
(773) 991-3016
NPI assigned
Sep 25, 2020
Last updated
Oct 23, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kathryn Jessie Wax, PSY.D.NPI 1497137046
Title
Clinical Psychologist/President
Phone
(773) 991-3016

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

644 W Webster Ave # B
Chicago, IL 60614-3710

Mailing address

644 W Webster Ave # B
Chicago, IL 60614-3710
Phone (773) 991-3016

Other identifiers 1

IdentifierTypeStateIssuer
1497137046MedicaidIL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603411200000",
    "number": "1013524818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "644 W WEBSTER AVE # B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606143710",
            "telephone_number": "773-991-3016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "644 W WEBSTER AVE # B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606143710",
            "telephone_number": "773-991-3016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN PARK PSYCHOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-25",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A",
        "authorized_official_last_name": "WAX",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "JESSIE",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST/PRESIDENT",
        "authorized_official_telephone_number": "773-991-3016",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497137046",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.