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General NPI Number Information
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NPI Number | 1558754226
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Entity Type | Individual
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Provider Name | ELLEN SOTOLOFF LCPC
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Gender | Female
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 495 CENTRAL AVE STE 203
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City | NORTHFIELD
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State | IL
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Zip | 60093-3044
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Country | US
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Telephone | 847-251-1046
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Fax | 847-789-7172
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Provider Business Mailing Address
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Address Line | 2112 MAGNOLIA LN
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-4217
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Country | US
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Telephone | 847-251-1046
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Fax | 847-789-7172
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180.005517
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License Number State | IL
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