Healthcare Provider Details

I. General information

NPI: 1568366748
Provider Name (Legal Business Name): ADAM DAVID ANTHONY MAUGHAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 W LAWRENCE AVE
CHICAGO IL
60640-4702
US

IV. Provider business mailing address

1320 W CHESTNUT ST APT 2F
CHICAGO IL
60642-5442
US

V. Phone/Fax

Practice location:
  • Phone: 773-569-1468
  • Fax:
Mailing address:
  • Phone: 801-803-0465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.023591
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: