Provider Demographics
NPI:1881689529
Name:TARTER, CHARLENE BARBARA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:BARBARA
Last Name:TARTER
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 1:5301 DEMPSTER ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1846
Mailing Address - Country:US
Mailing Address - Phone:847-679-1527
Mailing Address - Fax:847-679-1527
Practice Address - Street 1:5301 DEMPSTER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1846
Practice Address - Country:US
Practice Address - Phone:847-679-1527
Practice Address - Fax:847-679-1527
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
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
IL210117Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER