MEDICARE: DR. ALEXANDRIA E CARA PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071010175	IL

General Provider Information

NPI Number	:	1124663893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDRIA E CARA PSYD

Provider Business Mailing Address
First Line	:	3109 N SOUTHPORT AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3223
Country	:	US
Telephone Number	:	312-485-9801
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 N MICHIGAN AVE STE 1660
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-6022
Country	:	US
Telephone Number	:	312-485-9801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2019
Last Update Date	:	11/16/2019

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