=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558779389
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMITY PSYCHOLOGICAL SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2014
-----------------------------------------------------
Last Update Date | 09/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 EXECUTIVE DR 443
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60504-8137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-448-8000
-----------------------------------------------------
Fax | 630-448-8001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 EXECUTIVE DR 443
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60504-8137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-448-8000
-----------------------------------------------------
Fax | 630-448-8001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. TARANJIT KAUR BHATIA
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 630-448-8000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 071.008302
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------