Provider Demographics
NPI:1164538179
Name:HAMBURG, SAM R (PHD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:R
Last Name:HAMBURG
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 1:79 W MONROE ST
Mailing Address - Street 2:SUITE 1311
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-4901
Mailing Address - Country:US
Mailing Address - Phone:312-251-1405
Mailing Address - Fax:312-251-3161
Practice Address - Street 1:79 W MONROE ST
Practice Address - Street 2:SUITE 1311
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-4901
Practice Address - Country:US
Practice Address - Phone:312-251-1405
Practice Address - Fax:312-251-3161
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
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