Healthcare Provider Details

I. General information

NPI: 1073846440
Provider Name (Legal Business Name): JUDY LAU CARINO MSN,ANP,PMHNP,APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N HAMMES AVE STE 205
JOLIET IL
60435-8139
US

IV. Provider business mailing address

800 BLACK RD
JOLIET IL
60435-5942
US

V. Phone/Fax

Practice location:
  • Phone: 815-729-7790
  • Fax: 815-725-8144
Mailing address:
  • Phone: 815-727-6667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209004954
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209004954
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: