Provider Demographics
NPI:1265429195
Name:BARON, SHIRLEY REYNOLDS (PHD)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:REYNOLDS
Last Name:BARON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E CHESTNUT ST
Mailing Address - Street 2:#50K
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2051
Mailing Address - Country:US
Mailing Address - Phone:312-527-2940
Mailing Address - Fax:312-664-0024
Practice Address - Street 1:446 E ONTARIO ST
Practice Address - Street 2:SUITE #7-100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4418
Practice Address - Country:US
Practice Address - Phone:312-695-2090
Practice Address - Fax:312-695-5010
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK11054Medicare ID - Type Unspecified