Provider Demographics
NPI:1407903909
Name:JSR ASSOCIATES IN PSYCHOLOGY, LLP
Entity Type:Organization
Organization Name:JSR ASSOCIATES IN PSYCHOLOGY, LLP
Other - Org Name:TRANSFORMATIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CHERYL
Authorized Official - Last Name:JAKSA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-405-0220
Mailing Address - Street 1:420 LAKE COOK RD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5646
Mailing Address - Country:US
Mailing Address - Phone:847-405-0220
Mailing Address - Fax:847-405-0215
Practice Address - Street 1:420 LAKE COOK RD
Practice Address - Street 2:SUITE 113
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5646
Practice Address - Country:US
Practice Address - Phone:847-405-0220
Practice Address - Fax:847-405-0215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL073000052103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04972104OtherBLUE CROSS BLUE SHIELD
IL04972104OtherBLUE CROSS BLUE SHIELD