Provider Demographics
NPI:1649496019
Name:RICHARD N BOLNICK PSYD & ASSOCIATES PC
Entity type:Organization
Organization Name:RICHARD N BOLNICK PSYD & ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:BOLNICK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-549-6650
Mailing Address - Street 1:977 LAKEVIEW PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1400
Mailing Address - Country:US
Mailing Address - Phone:847-549-6650
Mailing Address - Fax:847-549-7005
Practice Address - Street 1:977 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1400
Practice Address - Country:US
Practice Address - Phone:847-549-6650
Practice Address - Fax:847-549-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003331103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty