Provider Demographics
NPI:1922295088
Name:STERN, CAROLYN BETH GEVIRTZ (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:BETH GEVIRTZ
Last Name:STERN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:BETH
Other - Last Name:GEVIRTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:928 N DELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-2020
Mailing Address - Country:US
Mailing Address - Phone:847-840-0594
Mailing Address - Fax:
Practice Address - Street 1:444 N NORTHWEST HWY STE 320
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3277
Practice Address - Country:US
Practice Address - Phone:847-220-7298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150010550104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker