Provider Demographics
NPI:1104187558
Name:CAROLYN E PLACKO LCSW PC
Entity type:Organization
Organization Name:CAROLYN E PLACKO LCSW PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PLACKO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-925-6124
Mailing Address - Street 1:4047 W PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3042
Mailing Address - Country:US
Mailing Address - Phone:312-925-6124
Mailing Address - Fax:773-202-1016
Practice Address - Street 1:3908 W MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1019
Practice Address - Country:US
Practice Address - Phone:312-925-6124
Practice Address - Fax:773-202-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060.0106421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty