South Shore Lake Front Services, Inc

Primary specialty

Group Psychotherapy PsychologistTaxonomy code 103TP2701X

Legal business name

SOUTH SHORE LAKE FRONT SERVICES, INC

Practice address

2619 E 75TH St # 21
Chicago, IL 60649-3705

Phone

(773) 375-1900

Fax

(773) 785-2091

NPI assigned

Jul 13, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Leonard Go

Title

Doctor

Phone

(773) 375-1900

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202428800000",
    "number": "1013932748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2619 E 75TH ST # 21",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606493705",
            "telephone_number": "773-375-1900",
            "fax_number": "773-785-2091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2619 E 75TH ST # 21",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606493705",
            "telephone_number": "773-375-1900",
            "fax_number": "773-785-2091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE LAKE FRONT SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2008-02-08",
        "status": "A",
        "authorized_official_last_name": "GO",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "773-375-1900",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Shore Foot and Ankle Wellness Center LLC
• South Shore Hospital Corporation
• South Shore Hospital Corporation (South Shore Hospital)
• South Shore Hospital Corporation
• South Shore Hospital Corporation
• South Shore Med & Rehab Center
• South Shore Radiologists, S.C.
• South Shore School of Leadership Health Center (Friedell Primary Care)
• South Side Healthy Community Organization, Inc
• South Side Help Center

• Group Psychotherapy Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Group Psychotherapy Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2008; 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.