Edessa Mirzapolos, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.010475 Issued in IL

Practice address

1415 Bond St Ste 127
Naperville, IL 60563-2769

Phone

(630) 355-9002

NPI assigned

Feb 10, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Sep 2, 2021 through Sep 2, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Edessa Mirzapolos, Psy.D. PLLC

  • Clinical Psychologist
  • Plainfield, IL
  • NPI 1740964204
  NPD Authorized official
• Dr Susan B Myket PC

  • Clinical Psychologist
  • Naperville, IL
  • NPI 1457570251
  NPD

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

{
    "created_epoch": "1612915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1417549478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5307 PAPAW DR",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605645348",
            "telephone_number": "773-387-6350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 BOND ST STE 127",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605632769",
            "telephone_number": "630-355-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRZAPOLOS",
        "first_name": "EDESSA",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-10",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.010475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paula Sue Mintchell, O.D.
• Charlotte Danette Minter-Jackson
• Fareha Mir, MD
• Sylwia Mirek
• Aleksander A. Mirski, M.D.
• Tina K Misantoni
• Dawn Marie Miskus, LCPC
• Marilyn Mistry, MD
• Miswak Dentistry Inc
• Becky Jane Mitarotondo, NP

• Clinical Psychologist in Naperville, IL
• Providers in Naperville, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.