Provider Demographics
NPI:1114779725
Name:CHRISTINE CARPENTER, PSYD AND ASSOCIATES
Entity Type:Organization
Organization Name:CHRISTINE CARPENTER, PSYD AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-339-1361
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1093983603OtherBCBSIL