MEDICARE: CAROLYN SELLERS 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	149018581	IL

General Provider Information

NPI Number	:	1871025940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN SELLERS LCSW

Provider Business Mailing Address
First Line	:	2539 N KEDZIE BLVD STE 4
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1435
Country	:	US
Telephone Number	:	312-620-0408
Fax Number	:

Provider Business Practice Location Address
First Line	:	2539 N KEDZIE BLVD STE 4
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1435
Country	:	US
Telephone Number	:	312-620-0408
Fax Number	:

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

Provider Enumeration Date	:	03/29/2017
Last Update Date	:	03/11/2020

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Directions to “ CAROLYN SELLERS LCSW” Practice Location

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