Healthcare Provider Details

I. General information

NPI: 1083036792
Provider Name (Legal Business Name): DEBORAH CARSTEN L.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 10/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 QUAIL RIDGE DRIVE
WESTMONT IL
60559
US

IV. Provider business mailing address

460 QUAIL RIDGE DRIVE
WESTMONT IL
60559
US

V. Phone/Fax

Practice location:
  • Phone: 630-887-2900
  • Fax: 630-986-2440
Mailing address:
  • Phone: 630-887-2900
  • Fax: 630-986-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number149017946
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number20-5676237
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: