Provider Demographics
NPI:1356846745
Name:POTACZEK, JOSEPH GERARD (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GERARD
Last Name:POTACZEK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 W CORTEZ ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3518
Mailing Address - Country:US
Mailing Address - Phone:773-485-0515
Mailing Address - Fax:312-253-1433
Practice Address - Street 1:77 W WASHINGTON ST STE 2110
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-9703
Practice Address - Country:US
Practice Address - Phone:312-637-8447
Practice Address - Fax:312-253-1433
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical