Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 180.011085 | IL |
Y | 101YP2500X | Professional Counselor | 180.011085 | IL |
N | 102L00000X | Psychologist | 180.011085 | IL |
N | 103T00000X | Psychologist | 180.011085 | IL |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 180.011085 | IL |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 180.011085 | IL |
N | 103G00000X | Clinical Psychologist | 180.011085 | IL |
N | 103TC0700X | Clinical Psychologist | 180.011085 | IL |
N | 103TF0000X | Family Psychologist | 180.011085 | IL |
N | 103TF0200X | Forensic Psychologist | 180.011085 | IL |
NPI | 1205293834 |
---|---|
Provider Name | Dr. Amr E. Abdel Kireem |
First Address | Algonquin, IL 60102-6206 |
Second Address | Rolling Meadows, IL 60008-4134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2016 |
Last Update Date | 04/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
EIN | STATE OF ILLINOIS (01) | IL |