Andrew D Carson, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.010080 Issued in IL

Practice address

420 Pennsylvania Ave Ste 101
Glen Ellyn, IL 60137-4427

Phone

(630) 474-4353

NPI assigned

Aug 11, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Marvelous Minds, Inc

  • Mental Health Counselor
  • Glen Ellyn, IL
  • NPI 1902319916

  Clinical

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565481600000",
    "number": "1346896966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 PENNSYLVANIA AVE STE 101",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601374427",
            "telephone_number": "630-621-8378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 PENNSYLVANIA AVE STE 101",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601374427",
            "telephone_number": "630-474-4353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARSON",
        "first_name": "ANDREW",
        "middle_name": "D",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-11",
        "last_updated": "2019-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.010080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Capps
• Care Hub LLC
• Judith Caribeaux, LCSW
• Caring Hands Lab & Phlebotomy, LLC
• Caroline C. Masek, LCPC, PLLC
• Jill A. Carter, SLP
• Carters Transportation
• Priscilla Medeiros Carvalho, M.D.
• Kerry Anne Cassidy, BCBA
• Leslie Castillo, AU.D.

• Clinical Psychologist in Glen Ellyn, IL
• Providers in Glen Ellyn, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.