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General NPI Number Information
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NPI Number | 1104187558
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Entity Type | Organization
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Legal Business Name | CAROLYN E PLACKO LCSW PC
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Dates
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Enumeration Date | 06/01/2012
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 3908 W MONTROSE AVE
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City | CHICAGO
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State | IL
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Zip | 60618-1019
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Country | US
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Telephone | 312-925-6124
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Fax | 773-202-1016
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Provider Business Mailing Address
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Address Line | 4047 W PATTERSON AVE
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City | CHICAGO
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State | IL
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Zip | 60641-3042
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Country | US
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Telephone | 312-925-6124
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Fax | 773-202-1016
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. CAROLYN E PLACKO
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Credential | LCSW
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Telephone | 312-925-6124
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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 | 060.010642
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License Number State | IL
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