Active NPI
Marilyn M Deboer, PH.D.
- Clinical Psychologist
- Glenview, IL
National Provider Identifier
1649493586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071.004805
- Practice address
- 1306 Waukegan Rd
#201
Glenview, IL 60025-3072 - Phone
- (847) 901-0909
- Fax
- (847) 901-0910
- NPI assigned
- Apr 10, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 071.004805 | IL | Primary |
Addresses
Primary practice location
1306 Waukegan Rd
#201
Glenview, IL 60025-3072
Mailing address
829 Ridge Ter
Evanston, IL 60201-2429
Phone (847) 869-4270
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 458586 | Other | IL | NEUROFEEDBACK |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.004805 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312848000000",
"number": "1649493586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "829 RIDGE TER",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602012429",
"telephone_number": "847-869-4270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1306 WAUKEGAN RD",
"address_2": "#201",
"city": "GLENVIEW",
"state": "IL",
"postal_code": "600253072",
"telephone_number": "847-901-0909",
"fax_number": "847-901-0910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBOER",
"first_name": "MARILYN",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-10",
"last_updated": "2011-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071.004805",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEUROFEEDBACK",
"identifier": "458586",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glenview, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.