Provider Demographics
NPI:1801016647
Name:STAUB, LAREA JOYCE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAREA
Middle Name:JOYCE
Last Name:STAUB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4817 HAMPSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-6273
Mailing Address - Country:US
Mailing Address - Phone:847-219-8670
Mailing Address - Fax:
Practice Address - Street 1:5211 BULL VALLEY RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7429
Practice Address - Country:US
Practice Address - Phone:847-219-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical