EDESSA MIRZAPOLOS PSYD
NPI 1417549478
Psychologist - Clinical in Naperville, IL

Q: What is Edessa Mirzapolos's NPI number?

The NPI number for Edessa Mirzapolos is 1417549478. It was assigned to this individual provider in the NPPES registry on February 10, 2021.

Q: What is Edessa Mirzapolos's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: Is Edessa Mirzapolos enrolled in Medicare?

No. Edessa Mirzapolos has opted out of Medicare through September 2, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Edessa Mirzapolos was last updated on February 10, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 10, 2021Opted out of Medicare · through Sep 2, 2027

1415 BOND ST STE 127, NAPERVILLE, IL 60563(630) 355-9002 Get Directions Write a Review

NPPES record last updated: February 10, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Edessa Mirzapolos Psyd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EDESSA MIRZAPOLOS PSYD (NPI 1417549478) is an individual clinical provider in Naperville, Illinois, licensed in Illinois (071.010475) and active in the NPI registry since February 2021. She has opted out of Medicare through September 2, 2027.

NPPES Registry Identity

NPI1417549478

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameEDESSA MIRZAPOLOSCredential: PSYD

Location Address1415 BOND ST STE 127Naperville, IL 60563-2769

Mailing Address5307 Papaw DrNaperville, IL 60564-5348 · (773) 387-6350

Phone(630) 355-9002

Sole ProprietorNo

Enumeration DateFebruary 10, 2021

NPPES CertifiedFebruary 10, 2021

✔ NPI 1417549478 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in IL · 071.010475

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

1415 BOND ST STE 127, Naperville, IL 60563

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Edessa Mirzapolos Psyd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from September 2, 2021 through September 2, 2027.

Opt-Out Effective DateSeptember 2, 2021

Opt-Out In Effect ThroughSeptember 2, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KRISTEN GULLIVER

Psychologist (Clinical)