Provider Demographics
NPI:1861687683
Name:AFSHAR, AZITA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AZITA
Middle Name:
Last Name:AFSHAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:AZITA
Other - Middle Name:
Other - Last Name:AFSHAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:30 N MICHIGAN AVE STE 900
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3766
Mailing Address - Country:US
Mailing Address - Phone:773-991-4417
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE STE 900
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3766
Practice Address - Country:US
Practice Address - Phone:773-991-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007791103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILACTIVEMedicare PIN