Provider Demographics
NPI:1629083043
Name:CARRILLO, DAVID VELEZ (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:VELEZ
Last Name:CARRILLO
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 1:204 N CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-4885
Mailing Address - Country:US
Mailing Address - Phone:847-934-6290
Mailing Address - Fax:847-359-5220
Practice Address - Street 1:675 N NORTH CT STE 260
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8141
Practice Address - Country:US
Practice Address - Phone:847-934-6290
Practice Address - Fax:847-359-5220
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490003111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical