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General NPI Number Information
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NPI Number | 1215625694
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Entity Type | Individual
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Provider Name | CARRIE JANE MARGARET GERSHOFF LPC
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Gender | Female
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 910 SKOKIE BLVD STE 103&215
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City | NORTHBROOK
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State | IL
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Zip | 60062-4013
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Country | US
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Telephone | 510-390-5595
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Fax |
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Provider Business Mailing Address
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Address Line | 2029 W CORTLAND ST # 1
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City | CHICAGO
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State | IL
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Zip | 60647-4501
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Country | US
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Telephone | 510-390-5595
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178017211
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License Number State | IL
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