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General NPI Number Information
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NPI Number | 1639612831
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Entity Type | Organization
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Legal Business Name | EMPATHIC RESONANCE, LLC
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 939 W NORTH AVE SUITE 750 OFFICE 721
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City | CHICAGO
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State | IL
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Zip | 60642
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Country | US
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Telephone | 312-623-0587
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Fax |
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Provider Business Mailing Address
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Address Line | 939 W NORTH AVE SUITE 750 OFFICE 721
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City | CHICAGO
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State | IL
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Zip | 60642
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Country | US
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Telephone | 312-623-0587
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Fax |
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Authorized Official
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Title or Position | CEO & FOUNDER
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Name | DR. FIRAS NAKSHABANDI
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Credential | M.D.
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Telephone | 747-444-0646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 036136493
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 036136493
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 036136493
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License Number State | IL
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