Active NPI
Elizabeth Scholom
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1568875045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071.010607
- Practice address
- 30 N Michigan Ave Ste 1914
Chicago, IL 60602-3623 - Phone
- (847) 861-0240
- NPI assigned
- Jun 3, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071.010607 | IL | Primary |
Addresses
Primary practice location
30 N Michigan Ave Ste 1914
Chicago, IL 60602-3623
Mailing address
480 W Deming PL
Chicago, IL 60614-1771
Phone (773) 203-5358
Other practice location 1
4141 N Kedzie Ave Ste 2
Chicago, IL 60618-2479
Phone (773) 203-5358
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200402002204 | NY | Order and Referring Only - Clinical Psychologist | 7618306226 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.010607 | IL | MD | Clinical Psychologist |
| 022931 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749686400000",
"number": "1568875045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "480 W DEMING PL",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606141771",
"telephone_number": "773-203-5358"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 N MICHIGAN AVE STE 1914",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606023623",
"telephone_number": "847-861-0240"
}
],
"practiceLocations": [
{
"address_1": "4141 N Kedzie Ave Ste 2",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606182479",
"country_code": "US",
"telephone_number": "773-203-5358",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SCHOLOM",
"first_name": "ELIZABETH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-03",
"last_updated": "2025-06-12",
"certification_date": "2025-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071.010607",
"primary": true
}
],
"identifiers": [],
"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 Jun 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.