Provider Demographics
NPI:1780714212
Name:BARSANO, CAROLYN ANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:ANNE
Last Name:BARSANO
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 1:4636 N VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2926
Mailing Address - Country:US
Mailing Address - Phone:773-259-4112
Mailing Address - Fax:
Practice Address - Street 1:4709 GOLF RD STE 1150
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1252
Practice Address - Country:US
Practice Address - Phone:773-259-4112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL071.007443103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health