Organization
CHICAGO BEHAVIORAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AZADEH GHAFFARI PH.D. (CLINICAL PSYCHOLOGIST)
(773) 850-0294
Entity
Organization
Contact information
Practice address
2502 N CLARK ST STE 206, CHICAGO, IL 60614-1850
(773) 850-0294
Mailing address
2502 N CLARK ST STE 206, CHICAGO, IL 60614-1850
(773) 850-0294
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071008535
IL
Other
Enumeration date
10/29/2016
Last updated
06/01/2020
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