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General NPI Number Information
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NPI Number | 1356689939
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Entity Type | Individual
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Provider Name | WHITNEY E SULLIVAN LCSW, RDT
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Gender | Female
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 4902 N LAWNDALE AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60625-5665
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Country | US
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Telephone | 317-695-7534
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Fax |
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Provider Business Mailing Address
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Address Line | 3033 W TOUHY AVE
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City | CHICAGO
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State | IL
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Zip | 60645-2833
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Country | US
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Telephone | 317-695-7534
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.015067
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License Number State | IL
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