NPIMap

Organization Active NPI

Equulibrium, LLC

  • Clinical Psychologist
  • Naperville, IL
National Provider Identifier
1255634002
Registry record updated Dec 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071.007415 Issued in IL
Legal business name
EQUULIBRIUM, LLC
Practice address
2603 S Washington St Ste 170
Naperville, IL 60565-6377
Phone
(630) 305-6180
NPI assigned
Dec 17, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2010

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

Authorized official

Name
Dr. Arieahn and William Matamonasa Bennett, PH.D.
Title
Clinical Psychologist
Phone
(630) 305-6180

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 071.007415 IL Primary

Addresses

Primary practice location

2603 S Washington St Ste 170
Naperville, IL 60565-6377

Mailing address

2603 S. Washington Street
Naperville, IL 60565
Phone (630) 305-6180

National Provider Directory

National Provider Directory

Locations

2603 S Washington St
Naperville, IL 60565
Phone (630) 357-8441

NPI Registry JSON

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

{
    "created_epoch": "1292544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292544000000",
    "number": "1255634002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2603 S. WASHINGTON STREET",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "60565",
            "telephone_number": "630-305-6180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2603 S WASHINGTON ST STE 170",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605656377",
            "telephone_number": "630-305-6180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EQUULIBRIUM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-17",
        "last_updated": "2010-12-17",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "ARIEAHN AND WILLIAM",
        "authorized_official_middle_name": "MATAMONASA",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "630-305-6180",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.007415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.

Verify at the official NPI Registry.