Active NPI
Irina Podolsky
- Clinical Psychologist
- Fairfield, IL
National Provider Identifier
1477827640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071.008298
- Practice address
- 1623 W Main St
Fairfield, IL 62837-2343 - Phone
- (312) 320-5137
- NPI assigned
- Mar 5, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071.008298 | IL | Primary |
Addresses
Primary practice location
1623 W Main St
Fairfield, IL 62837-2343
Mailing address
1623 W Main St
Fairfield, IL 62837-2343
Phone (312) 320-5137
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
| License | State | Type | Specialty |
|---|---|---|---|
| 071.008298 | IL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Irina Podolsky PSYD LLC | Clinical | Past | Accepting new patients |
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.
-
- Clinical Psychologist
- Fairfield, IL
- NPI 1962916015
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542067200000",
"number": "1477827640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1623 W MAIN ST",
"city": "FAIRFIELD",
"state": "IL",
"postal_code": "628372343",
"telephone_number": "312-320-5137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1623 W MAIN ST",
"city": "FAIRFIELD",
"state": "IL",
"postal_code": "628372343",
"telephone_number": "312-320-5137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PODOLSKY",
"first_name": "IRINA",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-03-05",
"last_updated": "2018-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071.008298",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.