NPIMap

Organization Active NPI

Dr Joseph Wallach PHD LLC

  • Clinical Psychologist
  • Evanston, IL
National Provider Identifier
1336415611
Registry record updated Mar 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071007942 Issued in IL
Legal business name
DR JOSEPH WALLACH PHD LLC
Practice address
2530 Crawford Ave
Suite 304
Evanston, IL 60201-4970
Phone
(773) 852-2400
Fax
(847) 869-8116
NPI assigned
Mar 30, 2012
Last updated
Mar 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2012

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

Authorized official

Name
Dr. Joseph Wallach, PH.D.NPI 1336453265
Title
Licensed Clinical Psychologist
Phone
(773) 852-2400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TB0200X 071007942 IL
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X 071007942 IL Primary
Health PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TH0004X 071007942 IL

Addresses

Primary practice location

2530 Crawford Ave
Suite 304
Evanston, IL 60201-4970

Mailing address

2741 W Greenleaf Ave
Chicago, IL 60645-3013
Phone (773) 852-2400

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1333065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333065600000",
    "number": "1336415611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2741 W GREENLEAF AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606453013",
            "telephone_number": "773-852-2400",
            "fax_number": "847-869-8116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 CRAWFORD AVE",
            "address_2": "SUITE 304",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014970",
            "telephone_number": "773-852-2400",
            "fax_number": "847-869-8116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR JOSEPH WALLACH PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-30",
        "last_updated": "2012-03-30",
        "status": "A",
        "authorized_official_last_name": "WALLACH",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "773-852-2400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "IL",
            "license": "071007942",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071007942",
            "primary": true
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Health",
            "state": "IL",
            "license": "071007942",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2012; 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.