Provider Demographics
NPI:1750780250
Name:BARRY, CYNTHIA (CRADC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 N SHERIDAN RD
Mailing Address - Street 2:STE 207
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7528
Mailing Address - Country:US
Mailing Address - Phone:312-620-0896
Mailing Address - Fax:
Practice Address - Street 1:4750 N SHERIDAN RD
Practice Address - Street 2:STE 207
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7528
Practice Address - Country:US
Practice Address - Phone:312-620-0896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22833101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)