Individual
CAROLYN BONISTALLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4806 FAIR ELMS AVE, WESTERN SPRINGS, IL 60558-1709
(708) 732-0654
Mailing address
4806 FAIR ELMS AVE, WESTERN SPRINGS, IL 60558-1709
(708) 732-0654
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149017041
IL
Other
Enumeration date
05/28/2015
Last updated
06/24/2021
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