MEDICARE: DR. CAROLBETH SHANSKY PHD

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	71-002123	IL

General Provider Information

NPI Number	:	1871688127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLBETH SHANSKY PHD

Provider Business Mailing Address
First Line	:	151 N MICHIGAN AVE
Second Line	:	SUITE 814
City	:	CHICAGO
State	:	IL
Zip	:	60601-7506
Country	:	US
Telephone Number	:	312-616-0006
Fax Number	:	773-348-2659

Provider Business Practice Location Address
First Line	:	151 N MICHIGAN AVE
Second Line	:	SUITE 814
City	:	CHICAGO
State	:	IL
Zip	:	60601-7506
Country	:	US
Telephone Number	:	312-616-0006
Fax Number	:	773-348-2659

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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