Provider Demographics
NPI:1225151657
Name:CARAS, RAEGAN A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RAEGAN
Middle Name:A
Last Name:CARAS
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 1:333 AMPHITHEATER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6667
Mailing Address - Country:US
Mailing Address - Phone:815-670-8429
Mailing Address - Fax:
Practice Address - Street 1:333 AMPHITHEATER DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6667
Practice Address - Country:US
Practice Address - Phone:815-670-8429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0102851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical