Provider Demographics
NPI:1245799725
Name:VAN DENBURG, ALYSSA NEWMAN (PHD)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:NEWMAN
Last Name:VAN DENBURG
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 E BELVIDERE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2015
Mailing Address - Country:US
Mailing Address - Phone:847-535-7647
Mailing Address - Fax:224-271-4960
Practice Address - Street 1:1475 E BELVIDERE RD STE 203
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2015
Practice Address - Country:US
Practice Address - Phone:847-535-7647
Practice Address - Fax:224-271-4960
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010838103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical