Provider Demographics
NPI:1881226280
Name:HARVEY, CARISSA (PSYD)
Entity type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:
Last Name:HARVEY
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12545 FARM HILL DR STE 400D
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-7913
Mailing Address - Country:US
Mailing Address - Phone:847-450-7193
Mailing Address - Fax:
Practice Address - Street 1:12545 FARM HILL DR STE 400D
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-7913
Practice Address - Country:US
Practice Address - Phone:847-450-7193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010231103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical