Provider Demographics
NPI:1568813939
Name:CARTY, ROBERT (LCSW, CADC, CCJP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CARTY
Suffix:
Gender:M
Credentials:LCSW, CADC, CCJP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 N DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3310
Mailing Address - Country:US
Mailing Address - Phone:312-631-7952
Mailing Address - Fax:312-943-3530
Practice Address - Street 1:867 N DEARBORN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3310
Practice Address - Country:US
Practice Address - Phone:312-631-7952
Practice Address - Fax:312-943-3530
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IL149.0094671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)