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General NPI Number Information
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NPI Number | 1043307796
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Entity Type | Individual
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Provider Name | CAROL BRUELL MSW LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3612 W LINCOLN HWY SUITE 4
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461
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Country | US
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Telephone | 708-309-2239
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Fax | 815-462-3962
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Provider Business Mailing Address
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Address Line | 2708 SCHOONER DRIVE
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City | NEW LENOX
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State | IL
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Zip | 60451
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Country | US
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Telephone | 708-309-2239
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Fax | 815-462-3962
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | IL
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