| Chicago Behavioral Clinic Llc | |
|
2502 N Clark St Ste 206 Chicago IL 60614-1850 | |
| (773) 850-0294 | |
| Not Available |
| Full Name | Chicago Behavioral Clinic Llc |
|---|---|
| Speciality | Psychologist |
| Location | 2502 N Clark St Ste 206, Chicago, Illinois |
| Authorized Official Name and Position | Azadeh Ghaffari (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 7738500294 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chicago Behavioral Clinic Llc 2502 N Clark St Ste 206 Chicago IL 60614-1850 Ph: (773) 850-0294 | Chicago Behavioral Clinic Llc 2502 N Clark St Ste 206 Chicago IL 60614-1850 Ph: (773) 850-0294 |
| NPI Number | 1821540428 |
|---|---|
| Provider Enumeration Date | 10/29/2016 |
| Last Update Date | 06/01/2020 |
| Certification Date | 06/01/2020 |
| Medicare PECOS PAC ID | 6204169253 |
|---|---|
| Medicare Enrollment ID | O20190606002800 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821540428 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071008535 (Illinois) | Primary |
| Provider Name | Sarah Maria Sarhaddi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184983397 PECOS PAC ID: 2668628744 Enrollment ID: I20120806000157 |
| Provider Name | Robin B Katz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619467669 PECOS PAC ID: 7416292065 Enrollment ID: I20181231000505 |
| Provider Name | Azadeh Ghaffari |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811236755 PECOS PAC ID: 4880833680 Enrollment ID: I20190606002858 |
| Provider Name | Joanna Buscemi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497473649 PECOS PAC ID: 3274909221 Enrollment ID: I20221018000017 |
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