Healthcare Provider Details

I. General information

NPI: 1962946541
Provider Name (Legal Business Name): SAMANTHA LEIGH KARREL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4753 N BROADWAY ST STE 403
CHICAGO IL
60640-7910
US

IV. Provider business mailing address

4753 N BROADWAY ST STE 403
CHICAGO IL
60640-7910
US

V. Phone/Fax

Practice location:
  • Phone: 739-892-7807
  • Fax:
Mailing address:
  • Phone: 773-989-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149027034
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0007319
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0007319
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: