Provider Demographics
NPI:1821371220
Name:SEPAH, SAVIZ (PHD)
Entity Type:Individual
Prefix:DR
First Name:SAVIZ
Middle Name:
Last Name:SEPAH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:CAMERON
Other - Middle Name:
Other - Last Name:SEPAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5000 S 5TH AVE, PSYCHOLOGY SERVICE (116B)
Mailing Address - Street 2:BUILDING 228, ROOM 3021
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-3030
Mailing Address - Country:US
Mailing Address - Phone:708-202-8387
Mailing Address - Fax:
Practice Address - Street 1:5000 S 5TH AVE, PSYCHOLOGY SERVICE (116B)
Practice Address - Street 2:BUILDING 228, ROOM 3012
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-3030
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral