Provider Demographics
NPI:1366766057
Name:SHIELDS, CAROLYN (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:SHIELDS
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 1:30W030 PRINCETON CT
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-1057
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:630-682-3094
Practice Address - Street 1:2172 BLACKBERRY DR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-1102
Practice Address - Country:US
Practice Address - Phone:630-797-9872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0112771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical