Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 71006420 | IL |
Y | 103TC0700X | Clinical Psychologist | 71006420 | IL |
NPI | 1013020452 |
---|---|
Provider Name | Joel Daniel Carnazzo |
First Address | Barrington, IL 60010-1833 |
Second Address | Barrington, IL 60010-1833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 30/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1632761 | BCBS PROVIDER # (01) | IL |