Provider Demographics
NPI:1841212883
Name:BULMASH, CAROLYN RENEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:RENEE
Last Name:BULMASH
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 1:9534 LAWLER AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1273
Mailing Address - Country:US
Mailing Address - Phone:847-213-0319
Mailing Address - Fax:
Practice Address - Street 1:6800 JOLIET RD
Practice Address - Street 2:
Practice Address - City:INDIANHEAD PARK
Practice Address - State:IL
Practice Address - Zip Code:60525-4460
Practice Address - Country:US
Practice Address - Phone:708-246-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2077756Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID #