Healthcare Provider Details

I. General information

NPI: 1497317143
Provider Name (Legal Business Name): VICTORIA MELISSA DOOBAY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 N KENMORE AVE STE 300
CHICAGO IL
60614-3504
US

IV. Provider business mailing address

2219 N KENMORE AVE STE 300
CHICAGO IL
60614-3504
US

V. Phone/Fax

Practice location:
  • Phone: 773-325-7780
  • Fax:
Mailing address:
  • Phone: 773-325-7780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.010056
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: