Provider Demographics
NPI:1881226280
Name:HARVEY, CARISSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:
Last Name:HARVEY
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 1:1301 INFANTA CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7010
Mailing Address - Country:US
Mailing Address - Phone:815-394-9116
Mailing Address - Fax:
Practice Address - Street 1:1717 DEERFIELD RD
Practice Address - Street 2:STE 110
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3900
Practice Address - Country:US
Practice Address - Phone:847-607-1416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical