Active NPI
Stephanie Carrera, PHD
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1942652292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071.009925
- Practice address
- 307 N Michigan Ave Ste 1014
Chicago, IL 60601-5310 - Phone
- (630) 536-9604
- NPI assigned
- Jul 11, 2016
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071.009925 | IL | Primary |
Addresses
Primary practice location
307 N Michigan Ave Ste 1014
Chicago, IL 60601-5310
Mailing address
307 N Michigan Ave Ste 1014
Chicago, IL 60601-5310
Phone (630) 536-9604
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| IL071009925 | Other | IL | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.009925 | IL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vita Nova PLLC | Clinical | 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.
-
- Clinical Psychologist
- Chicago, IL
- NPI 1255718094
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657756800000",
"number": "1942652292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "307 N MICHIGAN AVE STE 1014",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606015310",
"telephone_number": "630-536-9604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "307 N MICHIGAN AVE STE 1014",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606015310",
"telephone_number": "630-536-9604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARRERA",
"first_name": "STEPHANIE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-11",
"last_updated": "2022-07-14",
"certification_date": "2022-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071.009925",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "IL071009925",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.