Provider Demographics
NPI:1467604009
Name:KROMBEEN, CHARLENE MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MARIE
Last Name:KROMBEEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:KROMBEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:474 N LAKE SHORE DR
Mailing Address - Street 2:4902
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3400
Mailing Address - Country:US
Mailing Address - Phone:773-732-6414
Mailing Address - Fax:
Practice Address - Street 1:180 N MICHIGAN AVE
Practice Address - Street 2:SUITE 905
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7401
Practice Address - Country:US
Practice Address - Phone:773-732-6414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional