Provider Demographics
NPI:1417316670
Name:HARVEY, ANUPAMA (PHD)
Entity Type:Individual
Prefix:
First Name:ANUPAMA
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANUPAMA
Other - Middle Name:SHARMA
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1885 W GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2126
Mailing Address - Country:US
Mailing Address - Phone:414-446-8676
Mailing Address - Fax:
Practice Address - Street 1:225 E DEERPATH STE 280
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1973
Practice Address - Country:US
Practice Address - Phone:847-796-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.006230103TC0700X
IL071006230103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty