1457547457 NPI number — AFFILIATED CLINICAL PSYCHOLOGISTS LIMITED

Table of content: (NPI 1457547457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457547457 NPI number — AFFILIATED CLINICAL PSYCHOLOGISTS LIMITED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFFILIATED CLINICAL PSYCHOLOGISTS LIMITED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457547457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 TIFFANY PT
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
BLOOMINGDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60108-2936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-980-1400
Provider Business Mailing Address Fax Number:
630-980-1441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 TIFFANY PT
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
BLOOMINGDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60108-2936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-980-1400
Provider Business Practice Location Address Fax Number:
630-980-1441
Provider Enumeration Date:
09/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS-NEWON
Authorized Official First Name:
AIMEE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
630-980-1400

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02227626 . This is a "BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 215819 . This is a "MEDICARE GRP #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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