Nahrain Tavolacci, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071010126 Issued in IL

Practice address

390 E Devon Ave Ste 201
Roselle, IL 60172-1763

Phone

(630) 803-3524

NPI assigned

Aug 11, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Modern Me Psychology PCGroup PAC ID 8820427966, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Modern Me Psychology PC

  • Clinical Psychologist
  • Roselle, IL
  • NPI 1841830338

  Mental Health

  Medicare reassignment Care Compare group NPD Authorized official
• Mirjam Quinn and Associates, LTD

  • Clinical Psychologist
  • Chicago, IL
  • NPI 1730577685
  NPD (past)

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

{
    "created_epoch": "1470873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1750835328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "390 E. DEVON AVENUE",
            "address_2": "STE 201",
            "city": "ROSELLE",
            "state": "IL",
            "postal_code": "60172",
            "telephone_number": "630-358-9821",
            "fax_number": "847-565-4956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 E DEVON AVE STE 201",
            "city": "ROSELLE",
            "state": "IL",
            "postal_code": "601721763",
            "telephone_number": "630-803-3524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVOLACCI",
        "first_name": "NAHRAIN",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-11",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "IL",
            "license": "071010126",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071010126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Snyder-Mark Roselle Drugs Inc
• Soundways Hearing Health Inc
• Angela Staley
• Gina Szwed, RN
• Michael G Tavolacci, LPC
• Nabil E Tawfic, MS.PT
• Nicole Tellez, LMT
• The Ids Group
• Geetha N Thomas, DPT
• Megan Thoms

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.