Provider Demographics
NPI:1275741027
Name:EFFARAH, SAMER N (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:N
Last Name:EFFARAH
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 1:756 N LEAVITT ST APT 4N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1360
Mailing Address - Country:US
Mailing Address - Phone:773-383-0146
Mailing Address - Fax:
Practice Address - Street 1:756 N LEAVITT ST APT 4N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1360
Practice Address - Country:US
Practice Address - Phone:773-383-0146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007262103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist