Provider Demographics
NPI:1306159710
Name:CARL, AMY M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:CARL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 W TOUHY
Mailing Address - Street 2:COUNCIL FOR JEWISH ELDERLY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645
Mailing Address - Country:US
Mailing Address - Phone:773-508-1000
Mailing Address - Fax:773-508-1112
Practice Address - Street 1:3003 W TOUHY
Practice Address - Street 2:COUNCIL FOR JEWISH ELDERLY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645
Practice Address - Country:US
Practice Address - Phone:773-508-1000
Practice Address - Fax:773-508-1112
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.006220104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker