Provider Demographics
NPI:1104055011
Name:CALLAHAN, CAROLYN WESTERBERG (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:WESTERBERG
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:D
Other - Last Name:WESTERBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:701 E IRVING PARK RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2322
Mailing Address - Country:US
Mailing Address - Phone:847-529-1644
Mailing Address - Fax:
Practice Address - Street 1:701 E IRVING PARK RD
Practice Address - Street 2:SUITE 305
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2322
Practice Address - Country:US
Practice Address - Phone:847-529-1644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490020001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical