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General NPI Number Information
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NPI Number | 1114779725
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Entity Type | Organization
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Legal Business Name | CHRISTINE CARPENTER PSYD INC
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Dates
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Enumeration Date | 04/05/2024
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 801 SOUTH BLVD STE 1
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City | OAK PARK
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State | IL
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Zip | 60302-2855
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Country | US
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Telephone | 773-339-1361
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Fax |
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Provider Business Mailing Address
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Address Line | 801 SOUTH BLVD STE 1
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City | OAK PARK
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State | IL
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Zip | 60302-2855
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Country | US
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Telephone | 773-339-1361
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTINE CARPENTER
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Credential | PSYD
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Telephone | 773-339-1361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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