MEDICARE: DR. CASEY SHARPE PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071008189	IL

General Provider Information

NPI Number	:	1306224324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASEY SHARPE PSY.D.

Provider Business Mailing Address
First Line	:	3057 N CLYBOURN AVE APT 3S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-8328
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 MERCHANDISE MART PLZ
Second Line	:	OFFICE 4025
City	:	CHICAGO
State	:	IL
Zip	:	60654-1103
Country	:	US
Telephone Number	:	312-329-6609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2015
Last Update Date	:	05/11/2015

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