MEDICARE: CITY HAVEN

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	103T00000X	Psychologist	071008183	IL

General Provider Information

NPI Number	:	1386054682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY HAVEN

Provider Business Mailing Address
First Line	:	1735 N ASHLAND AVE
Second Line	:	OFFICE 201
City	:	CHICAGO
State	:	IL
Zip	:	60622-1435
Country	:	US
Telephone Number	:	847-830-4992
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 N ASHLAND AVE
Second Line	:	OFFICE 201
City	:	CHICAGO
State	:	IL
Zip	:	60622-1435
Country	:	US
Telephone Number	:	847-830-4992
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CLINICIAN
Name	:	DR. KATHERINE HARDING
Credential	:	PSYD
Telephone Number	:	847-830-4992

Provider Enumeration Date	:	05/07/2014
Last Update Date	:	05/07/2014

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Directions to “CITY HAVEN ” Practice Location

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