Individual provider Active NPI

Shauna Rosenberg Freedman, PSY.D.

  • Clinical Child & Adolescent Psychologist
  • Chicago, IL
National Provider Identifier
1396093126
Registry record updated Jan 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
071008949 Issued in IL
Practice address
1460 N Halsted St
Suite 503/504
Chicago, IL 60642-2605
Phone
(847) 686-0090
Fax
(847) 686-0090
NPI assigned
Aug 28, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X 071008949 IL Primary

Addresses

Primary practice location

1460 N Halsted St
Suite 503/504
Chicago, IL 60642-2605

Mailing address

1460 N Halsted St
Suite 503/504
Chicago, IL 60642-2605
Phone (847) 686-0090

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

State licenses

LicenseStateTypeSpecialty
071008949ILMDClinical Child & Adolescent Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1346112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422230400000",
    "number": "1396093126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 N HALSTED ST",
            "address_2": "SUITE 503/504",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606422605",
            "telephone_number": "847-686-0090",
            "fax_number": "847-686-0090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 N HALSTED ST",
            "address_2": "SUITE 503/504",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606422605",
            "telephone_number": "847-686-0090",
            "fax_number": "847-686-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREEDMAN",
        "first_name": "SHAUNA",
        "middle_name": "ROSENBERG",
        "name_prefix": "Ms.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-28",
        "last_updated": "2015-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "IL",
            "license": "071008949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; 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.