Chicago Behavioral Clinic LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071008535 Issued in IL

Legal business name

CHICAGO BEHAVIORAL CLINIC LLC

Practice address

2502 N Clark St Ste 206
Chicago, IL 60614-1850

Phone

(773) 850-0294

NPI assigned

Oct 29, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Azadeh Ghaffari, PH.D.NPI 1811236755

Title

Clinical Psychologist

Phone

(773) 850-0294

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 5

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

• Azadeh Ghaffari, PH.D.

  • Clinical Psychologist
  • Chicago, IL
  • NPI 1811236755
  Medicare reassignment Care Compare group NPD Authorized official
• Joanna Buscemi, PHD

  • Clinical Psychologist
  • Chicago, IL
  • NPI 1497473649
  Medicare reassignment Care Compare group NPD
• Kendall Martin, PSYD

  • Cognitive & Behavioral Psychologist
  • Chicago, IL
  • NPI 1710859970
  Medicare reassignment Care Compare group NPD
• Sarah Maria Sarhaddi, PSYD

  • Clinical Psychologist
  • Elmhurst, IL
  • NPI 1184983397
  Medicare reassignment Care Compare group NPD
• Haneen Efein, PSYD

  • Clinical Psychologist
  • Chicago, IL
  • NPI 1811473184
  NPD

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

{
    "created_epoch": "1477699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590969600000",
    "number": "1821540428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2502 N CLARK ST STE 206",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141850",
            "telephone_number": "773-850-0294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2502 N CLARK ST STE 206",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141850",
            "telephone_number": "773-850-0294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO BEHAVIORAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-29",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A",
        "authorized_official_last_name": "GHAFFARI",
        "authorized_official_first_name": "AZADEH",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "773-850-0294",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008535",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Chicago, IL
• Providers in Chicago, 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 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.