Provider Demographics
NPI:1093471575
Name:PRYOR, CHARISMA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHARISMA
Middle Name:S
Last Name:PRYOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5392
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-5392
Mailing Address - Country:US
Mailing Address - Phone:708-480-2705
Mailing Address - Fax:630-470-9342
Practice Address - Street 1:1755 PARK ST STE 200
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8404
Practice Address - Country:US
Practice Address - Phone:708-480-2705
Practice Address - Fax:630-470-9342
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490239751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical