Provider Demographics
NPI:1194150821
Name:MCBRIDE, CAMI KRISTEN (PHD)
Entity type:Individual
Prefix:
First Name:CAMI
Middle Name:KRISTEN
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 S MICHIGAN AVE
Mailing Address - Street 2:GAGE BLDG SUITE 400
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1315
Mailing Address - Country:US
Mailing Address - Phone:708-275-3240
Mailing Address - Fax:
Practice Address - Street 1:430 S MICHIGAN AVE
Practice Address - Street 2:GAGE BLDG SUITE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1315
Practice Address - Country:US
Practice Address - Phone:708-275-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007073103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical