Provider Demographics
NPI:1467500827
Name:JIARAS, MICHAEL THOMAS JR (PSYD, MA)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:JIARAS
Suffix:JR
Gender:M
Credentials:PSYD, MA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:366 WINNETKA AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-4239
Mailing Address - Country:US
Mailing Address - Phone:847-501-4200
Mailing Address - Fax:847-316-8625
Practice Address - Street 1:211 E ONTARIO ST STE 1150
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3248
Practice Address - Country:US
Practice Address - Phone:312-475-1635
Practice Address - Fax:847-316-8625
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical