Provider Demographics
NPI:1134220395
Name:CHOMICZ, CARRIE J (PSYD LP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:J
Last Name:CHOMICZ
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Gender:F
Credentials:PSYD LP
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:621 W LAKE ST
Mailing Address - Street 2:STE 350
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2952
Mailing Address - Country:US
Mailing Address - Phone:218-263-9237
Mailing Address - Fax:218-262-3150
Practice Address - Street 1:RANGE MENTAL HEALTH CENTER PERPICH BUILDING
Practice Address - Street 2:3203 W 3RD AVE
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746
Practice Address - Country:US
Practice Address - Phone:218-263-9237
Practice Address - Fax:218-262-3150
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2020-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNLP4616103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN837992100Medicaid
MN837992100Medicaid