Healthcare Provider Details

I. General information

NPI: 1073456117
Provider Name (Legal Business Name): CLARA MOLLER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 W BERWYN AVE STE 208
CHICAGO IL
60640-8060
US

IV. Provider business mailing address

1505 W GRANVILLE AVE APT 2
CHICAGO IL
60660-1866
US

V. Phone/Fax

Practice location:
  • Phone: 773-654-3322
  • Fax:
Mailing address:
  • Phone: 412-969-3126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.022709
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: