Active NPI
Mariam R Mourad, PH.D.
- Clinical Psychologist
- Evanston, IL
National Provider Identifier
1154623122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071008016
- Practice address
- 909 Davis St
Suite 160
Evanston, IL 60201-3683 - Phone
- (847) 425-6445
- NPI assigned
- Nov 24, 2010
- Sex
- Female
- Sole proprietor
- No
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 | 071008016 | IL | Primary |
Addresses
Primary practice location
909 Davis St
Suite 160
Evanston, IL 60201-3683
Mailing address
909 Davis St
Suite 160
Evanston, IL 60201-3683
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071008016 | IL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Endeavor Health Medical Group | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Anesthesiology Physician
- Evanston, IL
- NPI 1265695944
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1290556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290556800000",
"number": "1154623122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "909 DAVIS ST",
"address_2": "SUITE 160",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602013683"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "909 DAVIS ST",
"address_2": "SUITE 160",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602013683",
"telephone_number": "847-425-6445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOURAD",
"first_name": "MARIAM",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-11-24",
"last_updated": "2010-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071008016",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.