Provider Demographics
NPI:1093983603
Name:CARPENTER, CHRISTINE ELISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ELISE
Last Name:CARPENTER
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 1:801 SOUTH BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2855
Mailing Address - Country:US
Mailing Address - Phone:773-339-1361
Mailing Address - Fax:
Practice Address - Street 1:801 SOUTH BLVD STE 1
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2855
Practice Address - Country:US
Practice Address - Phone:773-339-1361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-16
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
IL071-006278103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty