Provider Demographics
NPI:1902526627
Name:UEBEL, CARLY MELISSA (AM, LSW)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:MELISSA
Last Name:UEBEL
Suffix:
Gender:F
Credentials:AM, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 W RASCHER AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-0899
Mailing Address - Country:US
Mailing Address - Phone:971-645-6080
Mailing Address - Fax:
Practice Address - Street 1:5100 N RAVENSWOOD AVE STE 238
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1752
Practice Address - Country:US
Practice Address - Phone:773-234-0513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.108716104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker