Edessa Mirzapolos, Psy.D. PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

EDESSA MIRZAPOLOS, PSY.D. PLLC

Practice address

24012 W Renwick Rd Ste 204
Plainfield, IL 60544-8733

Phone

(773) 387-6350

NPI assigned

Jun 14, 2023

Organization subpart

No

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

Authorized official

Name

Edessa Mirzapolos, PSYDNPI 1417549478

Title

Licensed Clinical Psychologist

Phone

(773) 387-6350

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edessa Mirzapolos, PSYD

  • Clinical Psychologist
  • Naperville, IL
  • NPI 1417549478
  NPD Authorized official

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

{
    "created_epoch": "1686700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686700800000",
    "number": "1740964204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13654 GOLDEN MEADOW DR",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605449842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24012 W RENWICK RD STE 204",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605448733",
            "telephone_number": "773-387-6350"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13654 Golden Meadow Dr",
            "address_purpose": "LOCATION",
            "city": "Plainfield",
            "state": "IL",
            "postal_code": "605449842",
            "country_code": "US",
            "telephone_number": "773-387-6350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EDESSA MIRZAPOLOS, PSY.D. PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-14",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-13",
        "status": "A",
        "authorized_official_last_name": "MIRZAPOLOS",
        "authorized_official_first_name": "EDESSA",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "773-387-6350",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• E Mediate Cure LLC
• Whitney Eagle
• Amanda Eaton, LPC
• Megan Eberle
• Eden Elon Medical PLLC
• Edgewood Clinical Services of Plainfield
• Edward Health Services Corporation
• Edward Health Ventures
• Edward Health Ventures
• Edward Health Ventures

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; 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.