Healthcare Provider Details

I. General information

NPI: 1154413987
Provider Name (Legal Business Name): CAROL GORE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 SAUNDERS RD
RIVERWOODS IL
60015-3835
US

IV. Provider business mailing address

240 SAUNDERS RD
RIVERWOODS IL
60015-3835
US

V. Phone/Fax

Practice location:
  • Phone: 847-236-1701
  • Fax: 847-236-1705
Mailing address:
  • Phone: 847-236-1701
  • Fax: 847-236-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: