Healthcare Provider Details

I. General information

NPI: 1295693513
Provider Name (Legal Business Name): SHAMARA CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W GARFIELD BLVD
CHICAGO IL
60636-1210
US

IV. Provider business mailing address

1717 W GARFIELD BLVD
CHICAGO IL
60636-1210
US

V. Phone/Fax

Practice location:
  • Phone: 312-545-4089
  • Fax:
Mailing address:
  • Phone: 312-545-4089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150117496
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number150117496
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: