Provider Demographics
NPI:1457334831
Name:CONNELL, CAROL (LCSW PLLC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:CONNELL
Suffix:
Gender:F
Credentials:LCSW PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1530
Mailing Address - Country:US
Mailing Address - Phone:476-129-5708
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 626
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3444
Practice Address - Country:US
Practice Address - Phone:847-612-9570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490019061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL585170Medicare ID - Type Unspecified