Healthcare Provider Details

I. General information

NPI: 1386853133
Provider Name (Legal Business Name): CARA LANZA HURLEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 N MICHIGAN AVE SUITE 2130
CHICAGO IL
60611-2615
US

IV. Provider business mailing address

202 47TH ST
WESTERN SPRINGS IL
60558-1628
US

V. Phone/Fax

Practice location:
  • Phone: 630-886-8878
  • Fax:
Mailing address:
  • Phone: 708-784-2438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: