Healthcare Provider Details

I. General information

NPI: 1871654665
Provider Name (Legal Business Name): CAROLYN GUERRA BURNS PSYD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RAVINIA AVE.
ORLAND PARK IL
60462
US

IV. Provider business mailing address

44 OAK CREEK DR.
BURR RIDGE IL
60527
US

V. Phone/Fax

Practice location:
  • Phone: 708-460-1212
  • Fax:
Mailing address:
  • Phone: 708-790-4062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071-6747
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-006747
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number071-006747
License Number StateIL

VIII. Authorized Official

Name: DR. CAROLYN GUERRA BURNS
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D
Phone: 708-790-4062