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General NPI Number Information
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NPI Number | 1770069577
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Entity Type | Individual
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Provider Name | MARY E CARLTON LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/15/2018
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Last Update Date | 07/15/2018
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Provider Practice Location Address
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Address Line | 688 N MILWAUKEE AVE STE 302
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City | CHICAGO
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State | IL
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Zip | 60642-5912
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Country | US
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Telephone | 312-771-6648
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Fax |
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Provider Business Mailing Address
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Address Line | 4438 N MONITOR AVE
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City | CHICAGO
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State | IL
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Zip | 60630-3333
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Country | US
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Telephone | 312-771-6648
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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 | 149.020439
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License Number State | IL
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