Healthcare Provider Details

I. General information

NPI: 1265688782
Provider Name (Legal Business Name): KAREN FRIED PSY.D., BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 W NORTH AVE SUITE 750
CHICAGO IL
60642-7138
US

IV. Provider business mailing address

939 W. NORTH AVENUE SUITE 750
CHICAGO IL
60642-7142
US

V. Phone/Fax

Practice location:
  • Phone: 312-646-2113
  • Fax: 312-646-2301
Mailing address:
  • Phone: 312-646-2113
  • Fax: 312-646-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-5502
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number0137751
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.008443
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: