Individual provider Active NPI

Christine Mary Deya, PSYD

  • Clinical Psychologist
  • Peoria, IL
National Provider Identifier
1457902165
Registry record updated Dec 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071010309 Issued in IL
Practice address
3716 W Brighton Ave
Peoria, IL 61615-2938
Phone
(309) 692-7755
NPI assigned
Sep 24, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 18, 2020

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 071010309 IL Primary

Addresses

Primary practice location

3716 W Brighton Ave
Peoria, IL 61615-2938

Mailing address

1840 N Drake Ave
Chicago, IL 60647-4821
Phone (585) 773-8550

Other practice location 1

801 South Blvd Ste 8
Oak Park, IL 60302-2855
Phone (585) 312-6839

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
071010309ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
John Day & Associates, LTD Clinical CurrentSince Dec 22, 2020 Accepting new patients

Locations

3716 W Brighton Ave
Peoria, IL 61615

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": "1569283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608249600000",
    "number": "1457902165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 N DRAKE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606474821",
            "telephone_number": "585-773-8550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3716 W BRIGHTON AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616152938",
            "telephone_number": "309-692-7755"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 South Blvd Ste 8",
            "address_purpose": "LOCATION",
            "city": "Oak Park",
            "state": "IL",
            "postal_code": "603022855",
            "country_code": "US",
            "telephone_number": "585-312-6839",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEYA",
        "first_name": "CHRISTINE",
        "middle_name": "MARY",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-24",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071010309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; 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.