Provider Demographics
NPI:1477852341
Name:CARLTON, JANE WARD (MDIV, MSMFT, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:WARD
Last Name:CARLTON
Suffix:
Gender:F
Credentials:MDIV, MSMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 SHERMER RD STE 313
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4575
Mailing Address - Country:US
Mailing Address - Phone:609-577-9081
Mailing Address - Fax:
Practice Address - Street 1:1363 SHERMER RD STE 313
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4575
Practice Address - Country:US
Practice Address - Phone:609-577-9081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006148101YP2500X
IL166.000821106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional