Provider Demographics
NPI:1770751976
Name:MAUCK, CAROL WEISSMANN (MSW, LCSW,ACSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:WEISSMANN
Last Name:MAUCK
Suffix:
Gender:F
Credentials:MSW, LCSW,ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3332
Mailing Address - Country:US
Mailing Address - Phone:217-359-7937
Mailing Address - Fax:217-359-3884
Practice Address - Street 1:609 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3332
Practice Address - Country:US
Practice Address - Phone:217-359-7937
Practice Address - Fax:217-359-3884
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490057421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical