Provider Demographics
NPI:1447704242
Name:MARLOWE, LARA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:
Last Name:MARLOWE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LARA
Other - Middle Name:
Other - Last Name:GIBLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:13 E WILSON ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-2656
Mailing Address - Country:US
Mailing Address - Phone:630-587-3777
Mailing Address - Fax:
Practice Address - Street 1:13 E WILSON ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-2656
Practice Address - Country:US
Practice Address - Phone:630-587-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0169041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical