Provider Demographics
NPI:1144332248
Name:CRAVEN, SHIRLEY (LCSW, PHD)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 N LAVERGNE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077
Mailing Address - Country:US
Mailing Address - Phone:847-674-5035
Mailing Address - Fax:847-674-5036
Practice Address - Street 1:241 GOLF MILL CENTER
Practice Address - Street 2:#403
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714
Practice Address - Country:US
Practice Address - Phone:847-674-5035
Practice Address - Fax:847-674-5036
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL384170Medicare ID - Type Unspecified