Provider Demographics
NPI:1134465644
Name:SOTOR, NICK J (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICK
Middle Name:J
Last Name:SOTOR
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 1:4212 N HAMLIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2016
Mailing Address - Country:US
Mailing Address - Phone:630-235-2922
Mailing Address - Fax:
Practice Address - Street 1:770 LAKE COOK RD STE 210
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4976
Practice Address - Country:US
Practice Address - Phone:847-607-9708
Practice Address - Fax:866-208-7391
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2662103TC0700X
IL071.009608103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical