MEDICARE: CARLY LUSK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	34011029A	IN
2	1041C0700X	Clinical Social Worker	149023828	IL

General Provider Information

NPI Number	:	1235891946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY LUSK LCSW

Provider Business Mailing Address
First Line	:	3811 S WALLACE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1749
Country	:	US
Telephone Number	:	804-814-7961
Fax Number	:

Provider Business Practice Location Address
First Line	:	681 LILLIE ST
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60120-4469
Country	:	US
Telephone Number	:	804-814-7961
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2021
Last Update Date	:	05/06/2026

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Directions to “ CARLY LUSK LCSW” Practice Location

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