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General NPI Number Information
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NPI Number | 1710038260
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Entity Type | Individual
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Provider Name | CARLA-JOY L CUMBERBATCH PH.D
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Gender | Female
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 18300 S HALSTED ST STE B113
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City | GLENWOOD
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State | IL
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Zip | 60425-1039
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Country | US
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Telephone | 773-531-7446
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Fax |
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Provider Business Mailing Address
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Address Line | 18300 S HALSTED ST STE B113
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City | GLENWOOD
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State | IL
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Zip | 60425-1039
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Country | US
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Telephone | 773-531-7446
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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 | 071006628
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License Number State | IL
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