Healthcare Provider Details

I. General information

NPI: 1073183554
Provider Name (Legal Business Name): ADAPT PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3046 W ARMITAGE AVE
CHICAGO IL
60647-5935
US

IV. Provider business mailing address

3046 W ARMITAGE AVE
CHICAGO IL
60647-5935
US

V. Phone/Fax

Practice location:
  • Phone: 872-588-6011
  • Fax:
Mailing address:
  • Phone: 585-233-7034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. MADELINE WILLIAM
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D
Phone: 585-233-7034