Provider Demographics
NPI:1538588231
Name:CLARE CHARLES LCSW
Entity type:Organization
Organization Name:CLARE CHARLES LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-943-8770
Mailing Address - Street 1:2034 N BURLING ST
Mailing Address - Street 2:2034 NORTH BURLING STREET
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4412
Mailing Address - Country:US
Mailing Address - Phone:312-943-8770
Mailing Address - Fax:
Practice Address - Street 1:2034 N BURLING ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4412
Practice Address - Country:US
Practice Address - Phone:312-943-8770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.002964251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management