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NPI Code Detail

MEDICARE: LYDIA SARAH THORNTON LCSW

MEDICARE: LYDIA SARAH THORNTON LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149022702IL

General Provider Information

NPI Number : 1760053698
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYDIA SARAH THORNTON LCSW
Provider Business Mailing Address
First Line : 992 1/2 GREEN BAY RD
Second Line :
City : WINNETKA
State : IL
Zip : 60093-1722
Country : US
Telephone Number : 847-446-8060
Fax Number :
Provider Business Practice Location Address
First Line : 992 1/2 GREEN BAY RD
Second Line :
City : WINNETKA
State : IL
Zip : 60093-1722
Country : US
Telephone Number : 847-446-8060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2021
Last Update Date : 07/01/2021

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Directions to “ LYDIA SARAH THORNTON LCSW” Practice Location

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