Provider Demographics
NPI:1881826105
Name:MANETTI, CARRIGAN (PSYD)
Entity Type:Individual
Prefix:
First Name:CARRIGAN
Middle Name:
Last Name:MANETTI
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 1:1280 IROQUOIS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8559
Mailing Address - Country:US
Mailing Address - Phone:630-305-0464
Mailing Address - Fax:630-305-0211
Practice Address - Street 1:1831 BAY SCOTT CIR STE 105
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1115
Practice Address - Country:US
Practice Address - Phone:630-305-0464
Practice Address - Fax:630-305-0211
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007545103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical