MODERN ME PSYCHOLOGY, INC. (NPI# 1841830338) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841830338 |
| Entity Type | Organization |
| Organization Name | MODERN ME PSYCHOLOGY, INC. |
| Other Organization Name | PEAK PERFORMANCE BIOFEEDBACK |
| Practice Address |
390 E Devon Ave Ste 201 Roselle IL 60172-1763 |
| Mailing Address |
223 W Country Dr Bartlett IL 60103-4674 |
| Practice Telephone | 6308033524 |
| Mailing Telephone | 6308033524 |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2020-03-09 |
| Authorized Official Name | DR. NAHRAIN D TAVOLACCI (LICENSED CLINICAL PSYCHOLOGIST) |
| Authorized Official Telephone | 6308033524 |
| Authorized Official Credential | PSY.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
Behavioral Health & Social Service Providers | ||
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
Behavioral Health & Social Service Providers | ||
| N | 103TH0004X |
Psychologist Specialization: Health |
Behavioral Health & Social Service Providers | ||
| N | 103TP2701X |
Psychologist Specialization: Group Psychotherapy |
Behavioral Health & Social Service Providers | ||
| N | 106E00000X | Assistant Behavior Analyst | Behavioral Health & Social Service Providers | ||
| N | 106S00000X | Behavior Technician | Behavioral Health & Social Service Providers | ||
| N | 2084N0600X |
Psychiatry & Neurology Specialization: Clinical Neurophysiology |
Allopathic & Osteopathic Physicians | ||
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| N | 101YP1600X |
Counselor Specialization: Pastoral |
Behavioral Health & Social Service Providers | ||
| N | 103G00000X | Clinical Neuropsychologist | Behavioral Health & Social Service Providers | ||
| N | 103TA0700X |
Psychologist Specialization: Adult Development & Aging |
Behavioral Health & Social Service Providers | ||
| N | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers | ||
| N | 102L00000X | Psychoanalyst | Behavioral Health & Social Service Providers | ||
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Peak Performance Biofeedback | Former Legal Business Name - Organization |
| Street Address |
390 E DEVON AVE STE 201 |
| City | ROSELLE |
| State | IL |
| Zip Code | 60172-1763 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518592872 | Michael G Tavolacci | Counselor | 390 E Devon Ave Ste 201, Roselle, IL 60172-1763 | 2020-03-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881292084 | Marsico Enterprises, LLC | In Home Supportive Care | 400 W. Lake Street, Suite 112c, Roselle, IL 60172 | 2020-10-12 |
| 1013483247 | Max Care Transportation Services, Inc. | Non-emergency Medical Transport (VAN) | 701 E Irving Park Rd Ste 201, Roselle, IL 60172 | 2018-10-15 |
| 1386137305 | Performance Physical Therapy LLC | Physical Therapist | 400 Lake St Ste 320b, Roselle, IL 60172 | 2018-06-13 |
| 1154780740 | Midwest Speech Therapy | Occupational Therapist | 975 E Nerge Road, Suite W20, Roselle, IL 60172 | 2016-02-11 |
| 1750790408 | Finite Dental LLC | Clinic/Center | 1530 W Lake St, Roselle, IL 60172 | 2014-08-07 |
| 1912292780 | Chris Ciaschini | Contractor | 401 S. Gary Ave, Suite 1, Roselle, IL 60172 | 2011-06-09 |
| 1306141916 | Access Elevator, Inc. | Contractor | 42 Congress Circle W, Roselle, IL 60172 | 2011-01-13 |
| 1568794113 | Jake Buranicz | Physical Medicine & Rehabilitation | 395 Rodenburg Rd., Home Health - Travel, Roselle, IL 60172 | 2010-02-08 |
| 1952565541 | Reema C Patel | Physical Therapist | 1540 W Lake St, Premier Physical Therapy, Roselle, IL 60172 | 2008-07-14 |
| 1669642294 | Max Care Home Health Services Inc. | Home Health | 701 East Irvin Park Road, Suite 106, Rosele, IL 60172 | 2008-03-11 |
| Find all providers in zip 60172 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114019510 | Kathleen A Parker | Psychologist | 225 E Irving Park Rd, Roselle, IL 60172-2004 | 2006-09-29 |
| 1528114014 | Joan M Hilby | Psychologist | 225 E Irving Park Rd, Roselle, IL 60172-2004 | 2007-01-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821699166 | Jennifer Knuepfer, Psyd, Pllc | Psychologist | 4256 N Ravenswood Ave Ste 305, Chicago, IL 60613-1114 | 2020-11-03 |
| 1104426170 | Grace Giedgowd | Psychologist | 1640 W Division St Apt 205, Chicago, IL 60622-3939 | 2020-10-29 |
| 1417556283 | Kjp Alliance LLC | Psychologist | 16595 W Easton Ave Ste 1, Lincolnshire, IL 60069-2744 | 2020-10-22 |
| 1184223364 | Caroline Elisabeth Fulton | Psychologist | 1739 N Elston Ave, Chicago, IL 60642-1544 | 2020-10-20 |
| 1881293108 | Haley Michelle Sims | Psychologist | 65 E Wacker Pl Ste 300, Chicago, IL 60601-7203 | 2020-10-19 |
| 1083212005 | Amanda Michele Long | Psychologist | 20280 Governors Hwy Ste 105, Olympia Fields, IL 60461-1068 | 2020-10-12 |
| 1285231936 | Qianhui Zhang | Psychologist | 1225 W Morse Ave Apt 403, Chicago, IL 60626-5751 | 2020-10-06 |
| 1316544158 | Nancy Marie Picard | Psychologist | 4885 N Hermitage Ave, Chicago, IL 60640-4104 | 2020-10-05 |
| 1558978379 | Youngok Kim | Psychologist | 1260 Iroquois Ave Ste 204, Naperville, IL 60563-8548 | 2020-09-25 |
| 1861007049 | Heloisa Garman | Psychologist | 800 Elgin Rd Apt 1611, Evanston, IL 60201-5632 | 2020-09-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.