NPIMap

Organization Active NPI

Carolyn Guerra Burns PSYD Inc

  • Clinical Psychologist
  • Orland Park, IL
National Provider Identifier
1871654665
Registry record updated Sep 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071-006747 Issued in IL
Legal business name
CAROLYN GUERRA BURNS PSYD INC
Practice address
200 Ravinia Ave.
Orland Park, IL 60462
Phone
(708) 460-1212
NPI assigned
Dec 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2014

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

Authorized official

Name
Dr. Carolyn Guerra Burns, PSY.DNPI 1114022506
Title
Clinical Psychologist
Phone
(708) 790-4062

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X 071-6747 IL
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X 071-006747 IL Primary
Clinical Child & Adolescent PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC2200X 071-006747 IL

Addresses

Primary practice location

200 Ravinia Ave.
Orland Park, IL 60462

Mailing address

44 Oak Creek Dr.
Burr Ridge, IL 60527
Phone (708) 790-4062

Other identifiers 1

IdentifierTypeStateIssuer
01635321OtherILBLUECROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070122000067 IL Part B Supplier - Clinic/Group Practice 4880695741 Receives reassigned benefits from 1 practitioner
Practice locations: Orland Park, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409702400000",
    "number": "1871654665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 OAK CREEK DR.",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "60527",
            "telephone_number": "708-790-4062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 RAVINIA AVE.",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "60462",
            "telephone_number": "708-460-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLYN GUERRA BURNS PSYD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2014-09-03",
        "status": "A",
        "authorized_official_last_name": "BURNS",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "GUERRA",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "708-790-4062",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071-6747",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071-006747",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "IL",
            "license": "071-006747",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUE SHIELD",
            "identifier": "01635321",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orland Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.