Provider Demographics
NPI:1093218737
Name:CARRIE SPITALLI, PSY.D., P.C.
Entity Type:Organization
Organization Name:CARRIE SPITALLI, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SPITALLI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:815-933-7887
Mailing Address - Street 1:110 MOONEY DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2172
Mailing Address - Country:US
Mailing Address - Phone:815-933-7887
Mailing Address - Fax:
Practice Address - Street 1:110 MOONEY DR STE 1
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2172
Practice Address - Country:US
Practice Address - Phone:815-933-7887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005739103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty