Provider Demographics
NPI:1326620642
Name:JAIN, DIVYA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2063 OLIVE HILL DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4644
Mailing Address - Country:US
Mailing Address - Phone:630-828-6867
Mailing Address - Fax:630-293-5814
Practice Address - Street 1:2063 OLIVE HILL DR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4644
Practice Address - Country:US
Practice Address - Phone:630-828-6867
Practice Address - Fax:630-293-5814
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X, 103T00000X, 103TA0700X, 103TB0200X, 103TC1900X, 103TH0004X, 103TM1800X, 103TR0400X, 103G00000X
IL071010532103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical