Provider Demographics
NPI:1447685888
Name:AMY CARNOW, PC
Entity type:Organization
Organization Name:AMY CARNOW, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNOW
Authorized Official - Suffix:
Authorized Official - Credentials:JD, LCSW
Authorized Official - Phone:224-544-9218
Mailing Address - Street 1:11 N SKOKIE HWY
Mailing Address - Street 2:SUTE 304
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1796
Mailing Address - Country:US
Mailing Address - Phone:224-544-9218
Mailing Address - Fax:
Practice Address - Street 1:11 N SKOKIE HWY
Practice Address - Street 2:SUTE 304
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1796
Practice Address - Country:US
Practice Address - Phone:224-544-9218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060011063261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)