MEDICARE: MS. HEDY E CARRERA LCPC, BCPC, EAP

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	101YP2500X	Professional Counselor	180-001918	IL

General Provider Information

NPI Number	:	1457435208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEDY E CARRERA LCPC, BCPC, EAP

Provider Business Mailing Address
First Line	:	2550 CRAWFORD AVE STE 22
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-4983
Country	:	US
Telephone Number	:	773-808-8345
Fax Number	:	847-492-1255

Provider Business Practice Location Address
First Line	:	2550 CRAWFORD AVE STE 22
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-4983
Country	:	US
Telephone Number	:	773-808-8345
Fax Number	:	847-492-1255

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	12/22/2010

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