Provider Demographics
NPI:1396533816
Name:DAS, DEBANJOLI (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEBANJOLI
Middle Name:
Last Name:DAS
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 1:1105 PLEASANT ST UNIT 411
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-0007
Mailing Address - Country:US
Mailing Address - Phone:636-346-8373
Mailing Address - Fax:
Practice Address - Street 1:1200 HARGER RD STE 600
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1820
Practice Address - Country:US
Practice Address - Phone:630-571-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071011442103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical