Active NPI
Bradley G Small, PSY.D.
- Clinical Psychologist
- Inverness, IL
National Provider Identifier
1669586574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- Practice address
- 1644 W Colonial Pkwy
Inverness, IL 60067-1207 - Phone
- (847) 776-4500
- Fax
- (847) 776-4724
- NPI assigned
- Aug 18, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- 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 | IA | Primary |
Addresses
Primary practice location
1644 W Colonial Pkwy
Inverness, IL 60067-1207
Mailing address
1202 Howard Cir
Wheaton, IL 60187-3811
Phone (630) 510-1929
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 |
|---|---|---|---|
| 071-005839 | IA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669586574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1202 HOWARD CIR",
"city": "WHEATON",
"state": "IL",
"postal_code": "601873811",
"telephone_number": "630-510-1929"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1644 W COLONIAL PKWY",
"city": "INVERNESS",
"state": "IL",
"postal_code": "600671207",
"telephone_number": "847-776-4500",
"fax_number": "847-776-4724"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMALL",
"first_name": "BRADLEY",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Inverness, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.