1619360872 NPI number — ANTHONY CARL REDMOND PSYD. M.A., CAADC

Table of content: ANTHONY CARL REDMOND PSYD. M.A., CAADC (NPI 1619360872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619360872 NPI number — ANTHONY CARL REDMOND PSYD. M.A., CAADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDMOND
Provider First Name:
ANTHONY
Provider Middle Name:
CARL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD. M.A., CAADC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REDMOND
Provider Other First Name:
ANTHONY
Provider Other Middle Name:
CARL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.H.S., L.P.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1619360872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1609 SIBLEY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALUMET CITY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60409-2217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-716-0534
Provider Business Mailing Address Fax Number:
708-841-5686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1609 SIBLEY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALUMET CITY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60409-2217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-716-0534
Provider Business Practice Location Address Fax Number:
708-841-5686
Provider Enumeration Date:
03/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  178.009745 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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