Provider Demographics
NPI:1750835328
Name:TAVOLACCI, NAHRAIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NAHRAIN
Middle Name:
Last Name:TAVOLACCI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 E. DEVON AVENUE
Mailing Address - Street 2:STE 201
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172
Mailing Address - Country:US
Mailing Address - Phone:630-358-9821
Mailing Address - Fax:847-565-4956
Practice Address - Street 1:390 E DEVON AVE STE 201
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-1763
Practice Address - Country:US
Practice Address - Phone:630-803-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010126103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent