Provider Demographics
NPI:1629138839
Name:DAMMRICH, MOIRA ANN CLAIR (PSYD)
Entity type:Individual
Prefix:DR
First Name:MOIRA
Middle Name:ANN CLAIR
Last Name:DAMMRICH
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 1:950 W MONROE ST
Mailing Address - Street 2:UNIT 510
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2788
Mailing Address - Country:US
Mailing Address - Phone:312-385-0460
Mailing Address - Fax:
Practice Address - Street 1:246 E JANATA BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5317
Practice Address - Country:US
Practice Address - Phone:630-424-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health