Provider Demographics
NPI:1558425546
Name:CRAVENS MANSINI, CARLA J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:J
Last Name:CRAVENS MANSINI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CARLA
Other - Middle Name:J
Other - Last Name:CRAVENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1801 WOODFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-9505
Mailing Address - Country:US
Mailing Address - Phone:217-722-1780
Mailing Address - Fax:
Practice Address - Street 1:1801 WOODFIELD DR
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9505
Practice Address - Country:US
Practice Address - Phone:217-722-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-007919101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1313003OtherMEDICARE