Provider Demographics
NPI:1306171772
Name:BARCZAK, AGORITSA RENEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:AGORITSA
Middle Name:RENEE
Last Name:BARCZAK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 E FABYAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1403
Mailing Address - Country:US
Mailing Address - Phone:630-444-1085
Mailing Address - Fax:630-262-4484
Practice Address - Street 1:757 E FABYAN PKWY
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1403
Practice Address - Country:US
Practice Address - Phone:630-444-1085
Practice Address - Fax:630-262-4484
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008462103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623882OtherBC/BS