Active NPI
Carly Walder, PSY.D.
- Psychologist
- Northbrook, IL
National Provider Identifier
1659685154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 071.009161
- Practice address
- 899 Skokie Blvd
Suite 204
Northbrook, IL 60062-4019 - Phone
- (847) 559-3240
- NPI assigned
- Jul 27, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 071.009161 | IL | Primary |
Addresses
Primary practice location
899 Skokie Blvd
Suite 204
Northbrook, IL 60062-4019
Mailing address
899 Skokie Blvd
Suite 204
Northbrook, IL 60062-4019
Phone (847) 559-3240
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 16, 2024 through Jan 16, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.009161 | IL | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Genevieveconkeythorntonllc | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Psychologist
- Northbrook, IL
- NPI 1215182548
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455580800000",
"number": "1659685154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "899 SKOKIE BLVD",
"address_2": "SUITE 204",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600624019",
"telephone_number": "847-559-3240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "899 SKOKIE BLVD",
"address_2": "SUITE 204",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600624019",
"telephone_number": "847-559-3240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALDER",
"first_name": "CARLY",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-27",
"last_updated": "2016-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IL",
"license": "071.009161",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.