Provider Demographics
NPI:1609519578
Name:CARLSON, STEPHEN THOMAS (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:THOMAS
Last Name:CARLSON
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 1:900 TECHNOLOGY WAY STE 320
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5364
Mailing Address - Country:US
Mailing Address - Phone:847-680-2715
Mailing Address - Fax:847-680-3832
Practice Address - Street 1:3 W HAWTHRON PARKWAY
Practice Address - Street 2:SUITE 120
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1441
Practice Address - Country:US
Practice Address - Phone:847-680-2715
Practice Address - Fax:847-680-3832
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical