Provider Demographics
NPI:1457547457
Name:AFFILIATED CLINICAL PSYCHOLOGISTS LIMITED
Entity Type:Organization
Organization Name:AFFILIATED CLINICAL PSYCHOLOGISTS LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS-NEWON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-980-1400
Mailing Address - Street 1:1 TIFFANY PT
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2936
Mailing Address - Country:US
Mailing Address - Phone:630-980-1400
Mailing Address - Fax:630-980-1441
Practice Address - Street 1:1 TIFFANY PT
Practice Address - Street 2:SUITE 111
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2936
Practice Address - Country:US
Practice Address - Phone:630-980-1400
Practice Address - Fax:630-980-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02227626OtherBLUE CROSS
IL215819OtherMEDICARE GRP #
IL02227626OtherBLUE CROSS