Healthcare Provider Details

I. General information

NPI: 1568071884
Provider Name (Legal Business Name): CONSTANCE MARIE MAY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 05/29/2021
Certification Date: 05/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 MAIN ST STE D
PARK RIDGE IL
60068-4060
US

IV. Provider business mailing address

1506 E FREMONT ST
ARLINGTON HEIGHTS IL
60004-6431
US

V. Phone/Fax

Practice location:
  • Phone: 847-823-4444
  • Fax:
Mailing address:
  • Phone: 847-373-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.010539
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: