Healthcare Provider Details

I. General information

NPI: 1639612831
Provider Name (Legal Business Name): EMPATHIC RESONANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 W NORTH AVE SUITE 750 OFFICE 721
CHICAGO IL
60642
US

IV. Provider business mailing address

939 W NORTH AVE SUITE 750 OFFICE 721
CHICAGO IL
60642
US

V. Phone/Fax

Practice location:
  • Phone: 312-623-0587
  • Fax:
Mailing address:
  • Phone: 312-623-0587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036136493
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number036136493
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number036136493
License Number StateIL

VIII. Authorized Official

Name: DR. FIRAS NAKSHABANDI
Title or Position: CEO & FOUNDER
Credential: M.D.
Phone: 747-444-0646