Provider Demographics
NPI:1093842890
Name:RICH, KAROLYN RUTH (LCSW)
Entity type:Individual
Prefix:MS
First Name:KAROLYN
Middle Name:RUTH
Last Name:RICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAROLYN
Other - Middle Name:RUTH
Other - Last Name:STANEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:217 BRUCE RD.
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-4906
Mailing Address - Country:US
Mailing Address - Phone:773-307-7205
Mailing Address - Fax:815-714-6244
Practice Address - Street 1:217 BRUCE RD.
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-4906
Practice Address - Country:US
Practice Address - Phone:773-307-7205
Practice Address - Fax:815-714-6244
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0066001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL20150720920191Medicaid