Healthcare Provider Details

I. General information

NPI: 1861778425
Provider Name (Legal Business Name): CARROLL KROIS-GIOCONDO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 N SHEFFIELD AVE
CHICAGO IL
60657-2210
US

IV. Provider business mailing address

3225 N SHEFFIELD AVE
CHICAGO IL
60657-2210
US

V. Phone/Fax

Practice location:
  • Phone: 773-549-5886
  • Fax: 773-435-0050
Mailing address:
  • Phone: 773-549-5886
  • Fax: 773-435-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149006339
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: