Healthcare Provider Details
I. General information
NPI: 1619779311
Provider Name (Legal Business Name): SARINE CARROLL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 03/25/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2160 S 1ST AVE STE 1940
MAYWOOD IL
60153-3328
US
IV. Provider business mailing address
210 N WELLS ST APT 2107
CHICAGO IL
60606-1341
US
V. Phone/Fax
- Phone: 708-216-6200
- Fax: 708-216-6840
- Phone: 248-520-5286
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 390200000X |
| Taxonomy | Student in an Organized Health Care Education/Training Program |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 125.087034 |
| License Number State | IL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: