Provider Demographics
NPI:1700337037
Name:CARLY WALDER, PSY.D., LLC
Entity Type:Organization
Organization Name:CARLY WALDER, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:WALDER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-529-5886
Mailing Address - Street 1:899 SKOKIE BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4019
Mailing Address - Country:US
Mailing Address - Phone:847-529-5886
Mailing Address - Fax:
Practice Address - Street 1:899 SKOKIE BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4019
Practice Address - Country:US
Practice Address - Phone:847-529-5886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty