=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427784511
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELAINE L CAREY PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2022
-----------------------------------------------------
Last Update Date | 07/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5547 N RAVENSWOOD AVE STE 201
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60640-1125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-349-2466
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5547 N RAVENSWOOD AVE STE 201
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60640-1125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-213-0433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 20043580A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------