Provider Demographics
NPI:1710574124
Name:TATAR, CAROLYN (ALMFT)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:TATAR
Suffix:
Gender:F
Credentials:ALMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 S GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4303
Mailing Address - Country:US
Mailing Address - Phone:773-613-0253
Mailing Address - Fax:
Practice Address - Street 1:1 E SUPERIOR ST STE 306
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2595
Practice Address - Country:US
Practice Address - Phone:773-549-7390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TF0000X
IL166001809106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily