Active NPI
NA'Ama Adam Wasserman, PSY.D.
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1790325744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071.006175
- Practice address
- 4753 N Broadway St Ste 900
Chicago, IL 60640-7908 - Phone
- (773) 989-2780
- NPI assigned
- Jan 7, 2020
- Sex
- Female
- 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 | 071.006175 | IL | Primary |
Addresses
Primary practice location
4753 N Broadway St Ste 900
Chicago, IL 60640-7908
Mailing address
2110 Saint Johns Ave Apt C
Highland Park, IL 60035-2411
Phone (224) 619-2348
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.006175 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578355200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578355200000",
"number": "1790325744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2110 SAINT JOHNS AVE APT C",
"city": "HIGHLAND PARK",
"state": "IL",
"postal_code": "600352411",
"telephone_number": "224-619-2348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4753 N BROADWAY ST STE 900",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606407908",
"telephone_number": "773-989-2780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ADAM WASSERMAN",
"first_name": "NA'AMA",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-07",
"last_updated": "2020-01-07",
"certification_date": "2020-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071.006175",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.