Provider Demographics
NPI:1861778425
Name:KROIS-GIOCONDO, CARROLL (LCSW)
Entity type:Individual
Prefix:MS
First Name:CARROLL
Middle Name:
Last Name:KROIS-GIOCONDO
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 1:3225 N SHEFFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2210
Mailing Address - Country:US
Mailing Address - Phone:773-549-5886
Mailing Address - Fax:773-435-0050
Practice Address - Street 1:3225 N SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2210
Practice Address - Country:US
Practice Address - Phone:773-549-5886
Practice Address - Fax:773-435-0050
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490063391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical