Healthcare Provider Details

I. General information

NPI: 1801636840
Provider Name (Legal Business Name): CAROLINE C. MASEK, LCPC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/29/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 HILLSIDE AVE
GLEN ELLYN IL
60137-4313
US

IV. Provider business mailing address

267 HILLSIDE AVE
GLEN ELLYN IL
60137-4313
US

V. Phone/Fax

Practice location:
  • Phone: 319-471-3359
  • Fax:
Mailing address:
  • Phone: 319-471-3359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE CHRISTINE MASEK
Title or Position: PROFESSIONAL COUNSELOR
Credential: LCPC
Phone: 319-471-3359