Doctor Name: | CAROLYN SUE PLOG |
NPI Number: | 1013135011 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW, LCSW |
License Number: | 149-008683 |
Business Practice Address: | 2900 Frank Scott Pkwy W Suite 956 Belleville, IL - 622235000 |
Business Phone Number: | 6182333273 |
Business Fax Number: | 6182347233 |
Mailing Address: | 2900 Frank Scott Pkwy W, Suite 956 BELLEVILLE |
State: | IL |
Postal Code: | 622235000 |
Phone Number: | 6182333273 |
Fax Number: | 6182347233 |
NPI Enumeration Date: | 04/23/2007 |
NPI Last Update Date: | 04/15/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149-008683 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |