Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071008535 | IL |
Y | 103TC0700X | Clinical Psychologist | 071008535 | IL |
N | 103TH0004X | Health Psychologist | 071008535 | IL |
NPI | 1811236755 |
---|---|
Provider Name | Dr. Azadeh Ghaffari |
First Address | Chicago, IL 60614-1850 |
Second Address | Chicago, IL 60614-1850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2013 |
Last Update Date | 06/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1821540428 | NPI2 (01) | IL |