Provider Demographics
NPI:1831547165
Name:SERE, CHARLOTTE (LCSW)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:SERE
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 1:1400 E 55TH PL
Mailing Address - Street 2:615 S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1876
Mailing Address - Country:US
Mailing Address - Phone:773-752-1926
Mailing Address - Fax:773-752-1926
Practice Address - Street 1:1400 E 55TH PL
Practice Address - Street 2:615 S
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1876
Practice Address - Country:US
Practice Address - Phone:773-752-1926
Practice Address - Fax:773-752-1926
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149000421103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst