Provider Demographics
NPI:1992218044
Name:TEAGUE, CARMEN (LCSW)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:TEAGUE
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 1:1041 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:BELLWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60104-2447
Mailing Address - Country:US
Mailing Address - Phone:708-642-6937
Mailing Address - Fax:
Practice Address - Street 1:715 LAKE ST STE 200
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1411
Practice Address - Country:US
Practice Address - Phone:708-642-6937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-12
Last Update Date:2017-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490189771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical