Provider Demographics
NPI:1003858572
Name:FURDA, R SCOTT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:R SCOTT
Middle Name:
Last Name:FURDA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE 333
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-631-8329
Mailing Address - Fax:773-631-8506
Practice Address - Street 1:7447 W TALCOTT
Practice Address - Street 2:SUITE 333
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631
Practice Address - Country:US
Practice Address - Phone:773-631-8329
Practice Address - Fax:773-631-8506
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004843103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01607654OtherBLUE CROSS BLUE SHIELD
300151523Medicare UPIN
IL01607654OtherBLUE CROSS BLUE SHIELD