Provider Demographics
NPI:1306007778
Name:PRIZM BEHAVIORAL SERVICES, PC
Entity Type:Organization
Organization Name:PRIZM BEHAVIORAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ASMAT
Authorized Official - Middle Name:Z
Authorized Official - Last Name:JAFRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-848-1200
Mailing Address - Street 1:PO BOX 2800
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-2800
Mailing Address - Country:US
Mailing Address - Phone:630-848-1200
Mailing Address - Fax:630-848-1208
Practice Address - Street 1:1112 S WASHINGTON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7959
Practice Address - Country:US
Practice Address - Phone:630-848-1200
Practice Address - Fax:630-848-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114959261Q00000X, 261QM0801X, 261QM0850X, 261QM0855X, 261QM2500X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114959Medicaid
ILI60233Medicare UPIN