Organization Active NPI

Patricia Kimbel PSYD PC

  • Clinical Psychologist
  • Libertyville, IL
National Provider Identifier
1215696752
Registry record updated Dec 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
PATRICIA KIMBEL PSYD PC
Practice address
1580 S Milwaukee Ave Ste 309
Libertyville, IL 60048-3773
Phone
(773) 490-7778
NPI assigned
Dec 13, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Patricia Kimbel, PSYD
Title
President
Phone
(773) 490-7778

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

1580 S Milwaukee Ave Ste 309
Libertyville, IL 60048-3773

Mailing address

3854 N Ridgeway Ave
Chicago, IL 60618-4014
Phone (773) 490-7778

National Provider Directory

National Provider Directory

Locations

1580 S Milwaukee Ave
Ste 309
Libertyville, IL 60048
Phone (773) 490-7778

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639353600000",
    "number": "1215696752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3854 N RIDGEWAY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606184014",
            "telephone_number": "773-490-7778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1580 S MILWAUKEE AVE STE 309",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483773",
            "telephone_number": "773-490-7778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRICIA KIMBEL PSYD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-13",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A",
        "authorized_official_last_name": "KIMBEL",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-490-7778",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.