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General NPI Number Information
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NPI Number | 1154440519
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Entity Type | Individual
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Provider Name | ANTHONY M DEJOSEPH PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 04/17/2020
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Provider Practice Location Address
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Address Line | 6201 CERMAK RD STE 2
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City | BERWYN
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State | IL
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Zip | 60402-5743
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Country | US
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Telephone | 708-214-7172
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Fax | 708-366-5556
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Provider Business Mailing Address
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Address Line | 6201 CERMAK RD STE 2
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City | BERWYN
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State | IL
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Zip | 60402-5743
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Country | US
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Telephone | 708-214-7172
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Fax | 708-366-5556
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071003731
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License Number State | IL
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