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General NPI Number Information
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NPI Number | 1740419381
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Entity Type | Individual
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Provider Name | THARA NAGARAJAN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 2219 N KENMORE AVE
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City | CHICAGO
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State | IL
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Zip | 60614-3504
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Country | US
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Telephone | 773-325-4659
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Fax |
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Provider Business Mailing Address
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Address Line | 3859 N OAKLEY AVE # 1
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City | CHICAGO
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State | IL
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Zip | 60618-3813
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Country | US
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Telephone | 773-771-0280
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Fax |
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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 | 071007439
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License Number State | IL
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