Provider Demographics
NPI:1033397237
Name:BANKY-LIVASY, KAREN LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LEE
Last Name:BANKY-LIVASY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LEE
Other - Last Name:BANKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3001 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3048
Mailing Address - Country:US
Mailing Address - Phone:224-610-3719
Mailing Address - Fax:224-610-3885
Practice Address - Street 1:3001 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:224-610-3719
Practice Address - Fax:224-610-3885
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI401231041C0700X
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker