Amy Fayazrad & Associates, PC
Organization Active NPI Psychologist · Glenview, IL
NPI 1184147647 · NPPES record last updated Jul 17, 2017
Key facts
- NPI
- 1184147647
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychologist 103T00000X
- Legal business name
- AMY FAYAZRAD & ASSOCIATES, PC
- Practice address
- 3633 W Lake Ave Ste 306
Glenview, IL 60026-5803 - Phone
- (760) 831-1191
- NPI assigned
- Jul 17, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Amy Fayazrad Fayazrad
- Title
- President
- Phone
- (760) 831-1191
Practitioners 1
-
Amy Fayazrad, PSY.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180710001193 | IL | Part B Supplier - Clinic/Group Practice | 2163778960 |
Receives reassigned benefits from 1 practitioner Practice locations: Glenview, IL |
National Provider Directory
Locations
2700 Patriot Blvd
Ste 240
Glenview, IL 60026
Phone (847) 651-5305
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist |
103T00000X | Yes |
Addresses
Primary practice location
3633 W Lake Ave Ste 306
Glenview, IL 60026-5803
Mailing address
4137 N Meade Ave
Chicago, IL 60634-1506
Other providers in Glenview, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.