Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | IL | |
N | 103TC0700X | Clinical Psychologist | IL | |
N | 102L00000X | Psychologist | IL | |
N | 103T00000X | Psychologist | IL | |
N | 103TA0700X | Adult Development & Aging Psychologist | IL | |
N | 103G00000X | Clinical Psychologist | IL | |
N | 103TC0700X | Clinical Psychologist | IL | |
N | 103TC1900X | Counseling Psychologist | IL | |
N | 103TF0000X | Family Psychologist | IL | |
N | 103TF0200X | Forensic Psychologist | IL | |
N | 103TH0100X | Health Service | IL | |
N | 103TP2701X | Group Psychotherapist | IL | |
N | 103TR0400X | Rehabilitation Psychologist | IL |
NPI | 1770560849 |
---|---|
Provider Name | Dr. Eliezer Tzvi Margolis |
First Address | Evanston, IL 60202-2203 |
Second Address | Evanston, IL 60202-2203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R19467 | (02) | IL |