Provider Demographics
NPI:1992879340
Name:PLATT, ANDREA SUSAN (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:SUSAN
Last Name:PLATT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 N MCCLURG CT
Mailing Address - Street 2:SUITE 513
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4326
Mailing Address - Country:US
Mailing Address - Phone:312-595-9547
Mailing Address - Fax:773-761-1064
Practice Address - Street 1:480 N MCCLURG CT
Practice Address - Street 2:SUITE 513
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4326
Practice Address - Country:US
Practice Address - Phone:312-595-9547
Practice Address - Fax:773-761-1064
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004186103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL946662Medicare ID - Type Unspecified