Provider Demographics
NPI:1417383209
Name:ALBERT, ARIELLE SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ARIELLE
Middle Name:SUSAN
Last Name:ALBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E WACKER PL
Mailing Address - Street 2:SUITE 2240
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7296
Mailing Address - Country:US
Mailing Address - Phone:860-751-8255
Mailing Address - Fax:
Practice Address - Street 1:65 E WACKER PL
Practice Address - Street 2:SUITE 2240
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7296
Practice Address - Country:US
Practice Address - Phone:860-751-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002617103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist