Provider Demographics
NPI:1588963383
Name:MOELLENHOFF, CARA LYNN (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:CARA
Middle Name:LYNN
Last Name:MOELLENHOFF
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 N 64TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-3809
Mailing Address - Country:US
Mailing Address - Phone:618-877-9530
Mailing Address - Fax:618-397-4503
Practice Address - Street 1:12 N 64TH ST STE 5
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-3809
Practice Address - Country:US
Practice Address - Phone:618-877-9530
Practice Address - Fax:618-397-4503
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490116561041C0700X
IL149.0116561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical