Provider Demographics
NPI:1508514498
Name:SILUNAS, CARISSA ANN (LSW)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:ANN
Last Name:SILUNAS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24735 W EAMES ST
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-8705
Mailing Address - Country:US
Mailing Address - Phone:815-416-9636
Mailing Address - Fax:
Practice Address - Street 1:24735 W EAMES ST
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-8705
Practice Address - Country:US
Practice Address - Phone:815-416-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150106389104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty