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General NPI Number Information
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NPI Number | 1366766057
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Entity Type | Individual
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Provider Name | CAROLYN SHIELDS LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 2172 BLACKBERRY DR
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City | GENEVA
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State | IL
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Zip | 60134-1102
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Country | US
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Telephone | 630-797-9872
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Fax |
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Provider Business Mailing Address
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Address Line | 30W030 PRINCETON CT
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City | WARRENVILLE
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State | IL
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Zip | 60555-1057
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Country | US
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Telephone |
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Fax | 630-682-3094
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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 | 149.011277
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License Number State | IL
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