Provider Demographics
NPI:1598065898
Name:CARBONE, MICHAEL (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CARBONE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 DEMPSTER ST STE 307
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8427
Mailing Address - Country:US
Mailing Address - Phone:847-544-5102
Mailing Address - Fax:847-544-5103
Practice Address - Street 1:2604 DEMPSTER ST STE 307
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8427
Practice Address - Country:US
Practice Address - Phone:847-544-5102
Practice Address - Fax:847-544-5103
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490141901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical