Provider Demographics
NPI:1881603728
Name:CARL, LENORA JEAN (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:LENORA
Middle Name:JEAN
Last Name:CARL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 N BAY DR
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-4270
Mailing Address - Country:US
Mailing Address - Phone:574-262-8116
Mailing Address - Fax:
Practice Address - Street 1:2801 E BRISTOL ST
Practice Address - Street 2:SUITE B
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-4300
Practice Address - Country:US
Practice Address - Phone:574-262-9319
Practice Address - Fax:574-262-2269
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003787A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200251470AMedicaid
IN200251470AMedicaid