Active NPI
Michelle Chaban, PSY.D.
- Clinical Psychologist
- Northbrook, IL
National Provider Identifier
1154378792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071-006496
- Practice address
- 1535 Lake Cook Rd
112
Northbrook, IL 60062-1447 - Phone
- (866) 220-8371
- NPI assigned
- May 28, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071-006496 | IL | Primary |
Addresses
Primary practice location
1535 Lake Cook Rd
112
Northbrook, IL 60062-1447
Mailing address
1640 Marcie CT
Deerfield, IL 60015-3974
Phone (847) 405-0520
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 19, 2021 through Jul 19, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071-006496 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365033600000",
"number": "1154378792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1640 MARCIE CT",
"city": "DEERFIELD",
"state": "IL",
"postal_code": "600153974",
"telephone_number": "847-405-0520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1535 LAKE COOK RD",
"address_2": "112",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621447",
"telephone_number": "866-220-8371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHABAN",
"first_name": "MICHELLE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-28",
"last_updated": "2013-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071-006496",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.