| Modern Me Psychology, Inc. | |
|
390 E Devon Ave Ste 201 Roselle IL 60172-1763 | |
| (630) 803-3524 | |
| Not Available |
| Full Name | Modern Me Psychology, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 390 E Devon Ave Ste 201, Roselle, Illinois |
| Authorized Official Name and Position | Nahrain D Tavolacci (LICENSED CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 6308033524 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Me Psychology, Inc. 223 W Country Dr Bartlett IL 60103-4674 Ph: (630) 803-3524 | Modern Me Psychology, Inc. 390 E Devon Ave Ste 201 Roselle IL 60172-1763 Ph: (630) 803-3524 |
| NPI Number | 1841830338 |
|---|---|
| Provider Enumeration Date | 01/13/2020 |
| Last Update Date | 03/09/2020 |
| Certification Date | 03/09/2020 |
| Medicare PECOS PAC ID | 8820427966 |
|---|---|
| Medicare Enrollment ID | O20200410001413 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841830338 | NPI | - | NPPES |
| Provider Name | Kathryn Juzwin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598774788 PECOS PAC ID: 5294742227 Enrollment ID: I20060315000493 |
| Provider Name | Nahrain Tavolacci |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750835328 PECOS PAC ID: 9739518879 Enrollment ID: I20200410001671 |
| Provider Name | Erin Terada |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255600599 PECOS PAC ID: 9335504828 Enrollment ID: I20230505002141 |
| Provider Name | Michael Tavolacci |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518592872 PECOS PAC ID: 5193154235 Enrollment ID: I20240312003090 |
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