| Doctor Name: | DR. ANTHONY M DEJOSEPH |
| NPI Number: | 1154440519 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSY.D. |
| License Number: | 071003731 |
| Business Practice Address: | 8311 Roosevelt Rd Suite 100 Forest Park, IL - 601302529 |
| Business Phone Number: | 7083665555 |
| Business Fax Number: | 7083665556 |
| Mailing Address: | 8311 Roosevelt Rd, Suite 100 FOREST PARK |
| State: | IL |
| Postal Code: | 601302529 |
| Phone Number: | 7083665555 |
| Fax Number: | 7083665556 |
| NPI Enumeration Date: | 03/28/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 071003731 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |