Provider Demographics
NPI:1194814350
Name:FRISCH, CARLA JAMESON (MA)
Entity Type:Individual
Prefix:MR
First Name:CARLA
Middle Name:JAMESON
Last Name:FRISCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 DAVIS ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4431
Mailing Address - Country:US
Mailing Address - Phone:847-425-7401
Mailing Address - Fax:
Practice Address - Street 1:820 DAVIS ST
Practice Address - Street 2:SUITE 450
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4431
Practice Address - Country:US
Practice Address - Phone:847-425-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK17977Medicare ID - Type UnspecifiedMEDICARE NUMBER