Envision Psychological Services, P.C.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071005965 Issued in IL

Legal business name

ENVISION PSYCHOLOGICAL SERVICES, P.C.

Practice address

1100 Cougar TRL
Cary, IL 60013-6057

Phone

(815) 388-9071

Fax

(847) 516-2510

NPI assigned

Nov 29, 2010

Last updated

Nov 29, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Susan M Stasek, PSYDNPI 1447221528

Title

Clinical Psychologist

Phone

(815) 388-9071

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Susan Stasek, PSYCHOLOGIST

  • Clinical Psychologist
  • Waukegan, IL
  • NPI 1447221528
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1290988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290988800000",
    "number": "1477855328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3221 MIDLANE DR",
            "city": "WADSWORTH",
            "state": "IL",
            "postal_code": "600839457",
            "telephone_number": "815-388-9071",
            "fax_number": "847-516-2510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 COUGAR TRL",
            "city": "CARY",
            "state": "IL",
            "postal_code": "600136057",
            "telephone_number": "815-388-9071",
            "fax_number": "847-516-2510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENVISION PSYCHOLOGICAL SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-29",
        "last_updated": "2010-11-29",
        "status": "A",
        "authorized_official_last_name": "STASEK",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "815-388-9071",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071005965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.