Provider Demographics
NPI:1861566275
Name:WEINBERG, CAROL O (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:O
Last Name:WEINBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:O
Other - Last Name:GLAZIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:426 PARK AVE E
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2627
Mailing Address - Country:US
Mailing Address - Phone:847-433-8407
Mailing Address - Fax:847-926-8180
Practice Address - Street 1:426 PARK AVE E
Practice Address - Street 2:SUITE 5
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2627
Practice Address - Country:US
Practice Address - Phone:847-433-8407
Practice Address - Fax:847-926-8180
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
32044OtherENH ILLINOIS
IL04932416OtherBCBS OF ILLINOIS
32044OtherENH ILLINOIS