Provider Demographics
NPI:1659721967
Name:IOFFE, MICAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:
Last Name:IOFFE
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 1:1438 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2150
Mailing Address - Country:US
Mailing Address - Phone:312-508-3645
Mailing Address - Fax:
Practice Address - Street 1:1438 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2150
Practice Address - Country:US
Practice Address - Phone:312-508-3645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010293103TC2200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent