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General NPI Number Information
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NPI Number | 1093812430
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Entity Type | Individual
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Provider Name | CAROLYN FEDERMAN MD
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4180 ROUTE 83 SUITE 10
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City | LONG GROVE
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State | IL
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Zip | 60047
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Country | US
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Telephone | 847-686-0037
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 387
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City | ADDISON
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State | IL
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Zip | 60101-0387
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Country | US
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Telephone | 847-686-0037
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | IL
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