Provider Demographics
NPI:1548031255
Name:NEW AGE PSYC PLLC
Entity type:Organization
Organization Name:NEW AGE PSYC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:IZABELA
Authorized Official - Last Name:CZUPRYNA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-323-7880
Mailing Address - Street 1:33 W HIGGINS RD STE 900
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9135
Mailing Address - Country:US
Mailing Address - Phone:847-323-7880
Mailing Address - Fax:
Practice Address - Street 1:33 W HIGGINS RD STE 900
Practice Address - Street 2:
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9135
Practice Address - Country:US
Practice Address - Phone:847-323-7880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty