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General NPI Number Information
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NPI Number | 1902526627
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Entity Type | Individual
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Provider Name | CARLY MELISSA UEBEL LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 5100 N RAVENSWOOD AVE STE 238
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City | CHICAGO
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State | IL
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Zip | 60640-1752
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Country | US
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Telephone | 773-234-0513
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Fax |
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Provider Business Mailing Address
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Address Line | 3204 SE 26TH AVE APT 2
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City | PORTLAND
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State | OR
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Zip | 97202-2100
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Country | US
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Telephone | 971-645-6080
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L16385
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.027814
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License Number State | IL
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