Provider Demographics
NPI:1376675215
Name:ESTRADA, CARRIE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:ESTRADA
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 1:1535 BURGUNDY PKWY
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1811
Mailing Address - Country:US
Mailing Address - Phone:630-518-6732
Mailing Address - Fax:
Practice Address - Street 1:1535 BURGUNDY PKWY
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107
Practice Address - Country:US
Practice Address - Phone:630-518-6732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0133301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15478OtherACSW