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General NPI Number Information
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NPI Number | 1538022579
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Entity Type | Individual
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Provider Name | CARLOS JUAN RIVERA-BABILONIA PSY.D
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Gender | Male
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 661 W LAKE ST STE 2S
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City | CHICAGO
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State | IL
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Zip | 60661-1034
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Country | US
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Telephone | 312-380-9041
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Fax |
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Provider Business Mailing Address
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Address Line | 1009 LORI LN APT D
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City | SPRINGFIELD
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State | IL
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Zip | 62712-7511
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.022551
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License Number State | IL
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