Provider Demographics
NPI:1730287210
Name:NIOLON, RICHARD ANTHONY (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:NIOLON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 N SHERIDAN RD
Mailing Address - Street 2:#3708
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1958
Mailing Address - Country:US
Mailing Address - Phone:773-561-1525
Mailing Address - Fax:
Practice Address - Street 1:500 N DEARBORN ST
Practice Address - Street 2:SUITE 1012
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-4900
Practice Address - Country:US
Practice Address - Phone:773-507-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633527OtherBCBS PIN NUMBER