Provider Demographics
NPI:1265688782
Name:FRIED, KAREN (PSYD, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:FRIED
Suffix:
Gender:F
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 W. NORTH AVENUE
Mailing Address - Street 2:SUITE 750
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-7142
Mailing Address - Country:US
Mailing Address - Phone:312-646-2113
Mailing Address - Fax:312-646-2301
Practice Address - Street 1:939 W NORTH AVE
Practice Address - Street 2:SUITE 750
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-7138
Practice Address - Country:US
Practice Address - Phone:312-646-2113
Practice Address - Fax:312-646-2301
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-09-5502103K00000X
NY0137751103TM1800X
IL071.008443103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities