Provider Demographics
NPI:1588790620
Name:CAREY, STEPHANIE ANNE (MA, LCPC)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANNE
Last Name:CAREY
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5149 ROWENA DR
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-9407
Mailing Address - Country:US
Mailing Address - Phone:815-703-7542
Mailing Address - Fax:
Practice Address - Street 1:5301 E STATE ST STE 302
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2399
Practice Address - Country:US
Practice Address - Phone:815-703-7542
Practice Address - Fax:815-977-5929
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007230101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health