Provider Demographics
NPI:1619360872
Name:REDMOND, ANTHONY CARL (PSYD MA, CAADC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CARL
Last Name:REDMOND
Suffix:
Gender:M
Credentials:PSYD MA, CAADC
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:CARL
Other - Last Name:REDMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHS, LPC
Mailing Address - Street 1:1609 SIBLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-2217
Mailing Address - Country:US
Mailing Address - Phone:708-716-0534
Mailing Address - Fax:708-841-5686
Practice Address - Street 1:1609 SIBLEY BLVD
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-2217
Practice Address - Country:US
Practice Address - Phone:708-716-0534
Practice Address - Fax:708-841-5686
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.009745103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist