Provider Demographics
NPI:1093378085
Name:PATEL, PAYAL J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAYAL
Middle Name:J
Last Name:PATEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 INDIANAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:IN
Mailing Address - Zip Code:46394-1956
Mailing Address - Country:US
Mailing Address - Phone:847-454-5179
Mailing Address - Fax:
Practice Address - Street 1:2230 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IN
Practice Address - Zip Code:46394-1956
Practice Address - Country:US
Practice Address - Phone:219-659-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043227A103TC0700X
IL071010004103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical