Active NPI
Andrew Joseph Blazsanyik, PSYD
- Clinical Psychologist
- Great Lakes, IL
National Provider Identifier
1972524882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071006897
- Practice address
- 3001A Sixth Street
Naval Health Center 9TH Floor
Great Lakes, IL 60088-5230 - Phone
- (847) 867-6961
- NPI assigned
- Jul 23, 2006
- 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 | 071006897 | IL | Primary |
Addresses
Primary practice location
3001A Sixth Street
Naval Health Center 9TH Floor
Great Lakes, IL 60088-5230
Mailing address
3001A Sixth Street
Naval Health Center 9TH Floor
Great Lakes, IL 60088-5230
Phone (847) 867-6961
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 |
|---|---|---|---|
| 071006897 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209686400000",
"number": "1972524882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3001A SIXTH STREET",
"address_2": "NAVAL HEALTH CENTER 9TH FLOOR",
"city": "GREAT LAKES",
"state": "IL",
"postal_code": "600885230",
"telephone_number": "847-867-6961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001A SIXTH STREET",
"address_2": "NAVAL HEALTH CENTER 9TH FLOOR",
"city": "GREAT LAKES",
"state": "IL",
"postal_code": "600885230",
"telephone_number": "847-867-6961"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAZSANYIK",
"first_name": "ANDREW",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-23",
"last_updated": "2008-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071006897",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Lakes, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.