Victoria Lasser, PHD
Individual provider Active NPI Clinical Psychologist · Glencoe, IL
NPI 1043597586 · NPPES record last updated Nov 11, 2011
Key facts
- NPI
- 1043597586
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 071003867 (IL)
- Practice address
- 545 Park Ave
Glencoe, IL 60022-1501 - Phone
- (312) 595-9755
- Fax
- (847) 835-4342
- NPI assigned
- Nov 11, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
- Opted out of Medicare
- Yes, effective Jan 13, 2016 through Jan 13, 2028
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Victoria Lasser, PH.D., P.C. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071003867 | IL | Yes |
Addresses
Primary practice location
545 Park Ave
Glencoe, IL 60022-1501
Mailing address
545 Park Ave
Glencoe, IL 60022-1501
Phone (312) 595-9755
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All providers in Glencoe, IL · Clinical Psychologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 11, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.