Provider Demographics
NPI:1669689550
Name:CARROLL, EMILY BARBARA (MA, LCSW)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:BARBARA
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MA, LCSW
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Mailing Address - Street 1:330 W DIVERSEY PKWY
Mailing Address - Street 2:APARTMENT 401
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6262
Mailing Address - Country:US
Mailing Address - Phone:773-975-4024
Mailing Address - Fax:312-440-9563
Practice Address - Street 1:1707 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5501
Practice Address - Country:US
Practice Address - Phone:312-440-1203
Practice Address - Fax:312-440-9563
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical