Provider Demographics
NPI:1780920579
Name:HAYSE, CAROL JUNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JUNE
Last Name:HAYSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7448 N DAMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2258
Mailing Address - Country:US
Mailing Address - Phone:773-465-6430
Mailing Address - Fax:
Practice Address - Street 1:7448 N DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-2258
Practice Address - Country:US
Practice Address - Phone:773-465-6430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-25
Last Update Date:2012-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.011839101YP2500X, 1041C0700X
IL19387541041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool