Active NPI
David Edward Victorson, PHD
- Clinical Psychologist
- Glenview, IL
National Provider Identifier
1609043553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071-007103
- Practice address
- 2400 Chestnut Ave
Glenview Park Center - Integrative Medicine, Suite a
Glenview, IL 60026-8321 - Phone
- (847) 657-3540
- Fax
- (847) 657-3530
- NPI assigned
- May 9, 2008
- Sex
- Male
- Sole proprietor
- No
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 | 071-007103 | IL | Primary |
Addresses
Primary practice location
2400 Chestnut Ave
Glenview Park Center - Integrative Medicine, Suite a
Glenview, IL 60026-8321
Mailing address
2650 Ridge Ave
Evanston Hospital
Evanston, IL 60201-1718
Phone (847) 570-1206
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 071007103 | Other | IL | IL STATE LIC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071-007103 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210291200000",
"number": "1609043553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2650 RIDGE AVE",
"address_2": "EVANSTON HOSPITAL",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602011718",
"telephone_number": "847-570-1206",
"fax_number": "847-570-1248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 CHESTNUT AVE",
"address_2": "GLENVIEW PARK CENTER - INTEGRATIVE MEDICINE, SUITE A",
"city": "GLENVIEW",
"state": "IL",
"postal_code": "600268321",
"telephone_number": "847-657-3540",
"fax_number": "847-657-3530"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VICTORSON",
"first_name": "DAVID",
"middle_name": "EDWARD",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-09",
"last_updated": "2008-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071-007103",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IL STATE LIC",
"identifier": "071007103",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glenview, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 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.