Provider Demographics
NPI:1114152816
Name:CHEN, JOSEPH (PHD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2193
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-2193
Mailing Address - Country:US
Mailing Address - Phone:312-835-7988
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 824
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3487
Practice Address - Country:US
Practice Address - Phone:312-835-7988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-25
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007676103TC0700X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071-007676Other071007676