Provider Demographics
NPI:1154964146
Name:CHAPIN, BERNARD P (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:P
Last Name:CHAPIN
Suffix:
Gender:M
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-1210
Mailing Address - Country:US
Mailing Address - Phone:773-972-9952
Mailing Address - Fax:
Practice Address - Street 1:6820 S WASHTENAW AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-1826
Practice Address - Country:US
Practice Address - Phone:773-548-8705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL542289103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL542289OtherILLINOIS ELIS LICENCE NUMBER