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General NPI Number Information
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NPI Number | 1720156201
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Entity Type | Organization
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Legal Business Name | AFFILIATED CLINICAL PSYCHOLOGISTS
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 1 TIFFANY PT STE. #111
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2936
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Country | US
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Telephone | 630-980-1400
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Fax | 630-980-1441
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Provider Business Mailing Address
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Address Line | 1 TIFFANY PT STE. #111
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2936
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Country | US
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Telephone | 630-980-1400
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Fax | 630-980-1441
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Authorized Official
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Title or Position | OWNER
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Name | AIMEE HARRIS-NEWON
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Credential | PSY.D.
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Telephone | 630-980-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071-005865
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License Number State | IL
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