Provider Demographics
NPI:1801106729
Name:NEAFSEY, JOHN P (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:NEAFSEY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 N BROADWAY ST STE 24
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1477
Mailing Address - Country:US
Mailing Address - Phone:773-338-4334
Mailing Address - Fax:
Practice Address - Street 1:6355 N BROADWAY ST STE 24
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1477
Practice Address - Country:US
Practice Address - Phone:773-338-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005033103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical