Michael J Di Domenico, PSYD is a
Clinical Neuropsychologist based in Northbrook, Illinois. Michael J Di Domenico is licensed to practice in Illinois (license number 071005762) and his current practice location is
707 Skokie Blvd Ste 600, Northbrook, Illinois. He can be reached at his office (for appointments etc.) via phone at
(630) 632-0746.
NPI number for Michael J Di Domenico is 1861442345 and his current mailing address is Po Box 472, Northbrook, Illinois. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1861442345.
Healthcare Provider's Profile
| Full Name | Michael J Di Domenico |
|---|
| Gender | Male |
|---|
| Speciality | Clinical Neuropsychologist |
|---|
| Location | 707 Skokie Blvd Ste 600, Northbrook, Illinois |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1861442345
- Provider Enumeration Date: 05/12/2006
- Last Update Date: 07/25/2022
Medical Identifiers
Medical identifiers for Michael J Di Domenico such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1861442345 | NPI | - | NPPES |
| 1623280 | Other | IL | BLUE CROSS BLUE SHIELD |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103TC0700X | Psychologist - Clinical | 071055762 (Illinois) | Secondary |
| 103TC0700X | Psychologist - Clinical | 071005762 (Illinois) | Secondary |
| 103G00000X | Clinical Neuropsychologist | 071005762 (Illinois) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Michael J Di Domenico is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Michael J Di Domenico, PSYD
Po Box 472,
Northbrook, IL 60065-0472
Ph: (847) 504-4060 | Michael J Di Domenico, PSYD
707 Skokie Blvd Ste 600,
Northbrook, IL 60062-2841
Ph: (630) 632-0746 |
Reviews and Comments