Provider Demographics
NPI:1871745406
Name:MOSES-ROBINSON, CAROL ARLENE (MA, PSYD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ARLENE
Last Name:MOSES-ROBINSON
Suffix:
Gender:F
Credentials:MA, PSYD
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:ARLENE
Other - Last Name:MOSES-ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, PSYD
Mailing Address - Street 1:7430 S PAXTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-3215
Mailing Address - Country:US
Mailing Address - Phone:773-288-0479
Mailing Address - Fax:773-288-0479
Practice Address - Street 1:110 E 79TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-2302
Practice Address - Country:US
Practice Address - Phone:773-562-5923
Practice Address - Fax:773-288-0479
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042064A103T00000X
IL071.007855103TC0700X
IL149.0046041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical