Provider Demographics
NPI:1164534897
Name:DEBELLIS, EDWARD CARMINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CARMINE
Last Name:DEBELLIS
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 1:710 N WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-7251
Mailing Address - Country:US
Mailing Address - Phone:847-358-4719
Mailing Address - Fax:847-202-8629
Practice Address - Street 1:509 W MAIN ST
Practice Address - Street 2:SUITE 1-D
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6827
Practice Address - Country:US
Practice Address - Phone:847-713-2119
Practice Address - Fax:847-202-8629
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL941910Medicare ID - Type Unspecified