Provider Demographics
NPI:1285250688
Name:CARRASCO, ASHLEY (LSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 S LANGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4766
Mailing Address - Country:US
Mailing Address - Phone:219-484-8918
Mailing Address - Fax:
Practice Address - Street 1:137 N OAK PARK AVE STE 327
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1375
Practice Address - Country:US
Practice Address - Phone:219-484-8918
Practice Address - Fax:708-848-2876
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150103945104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker