Individual provider Active NPI

Marci Etienne, PH.D.

  • Clinical Psychologist
  • Lake Zurich, IL
National Provider Identifier
1427738244
Registry record updated Jul 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071.009350 Issued in IL
Practice address
61 S Old Rand Rd
Lake Zurich, IL 60047-3127
Phone
(847) 438-4222
NPI assigned
Jul 18, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 071.009350 IL Primary

Addresses

Primary practice location

61 S Old Rand Rd
Lake Zurich, IL 60047-3127

Mailing address

61 S Old Rand Rd
Lake Zurich, IL 60047-3127
Phone (847) 438-4222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240806000541 IL Practitioner - Clinical Psychologist 9133666399 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cherry Hill Associates, LLCGroup PAC ID 1557523552, 25 clinicians

Practice addresses (Care Compare)

61 S Old Rand Rd
Lake Zurich, IL 60047-3127
Phone (847) 438-4222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
071.009350ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Cherry Hill Associates, LLC CurrentSince Jul 24, 2024 Accepting new patients

Locations

61 S Old Rand Rd
Lake Zurich, IL 60047
Phone (847) 438-4222

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1689638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1427738244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 S OLD RAND RD",
            "city": "LAKE ZURICH",
            "state": "IL",
            "postal_code": "600473127",
            "telephone_number": "847-438-4222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 S OLD RAND RD",
            "city": "LAKE ZURICH",
            "state": "IL",
            "postal_code": "600473127",
            "telephone_number": "847-438-4222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETIENNE",
        "first_name": "MARCI",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-18",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.009350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Zurich, IL

Sources for this page

Verify at the official NPI Registry.