Healthcare Provider Details

I. General information

NPI: 1881226280
Provider Name (Legal Business Name): CARISSA HARVEY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12545 FARM HILL DR STE 400D
HUNTLEY IL
60142-7913
US

IV. Provider business mailing address

12545 FARM HILL DR STE 400D
HUNTLEY IL
60142-7913
US

V. Phone/Fax

Practice location:
  • Phone: 847-450-7193
  • Fax:
Mailing address:
  • Phone: 847-450-7193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071.010231
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.010231
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: