Provider Demographics
NPI:1861801458
Name:MOSS, CAROL SOLBERG (LCSW)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:SOLBERG
Last Name:MOSS
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 1:1920 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2369
Mailing Address - Country:US
Mailing Address - Phone:847-251-7248
Mailing Address - Fax:
Practice Address - Street 1:1920 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2369
Practice Address - Country:US
Practice Address - Phone:847-251-7248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0094001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical