Provider Demographics
NPI:1003332792
Name:ROSENTHAL SHEPARD, GIANNA (LCSW, MED)
Entity Type:Individual
Prefix:MRS
First Name:GIANNA
Middle Name:
Last Name:ROSENTHAL SHEPARD
Suffix:
Gender:F
Credentials:LCSW, MED
Other - Prefix:MRS
Other - First Name:GIANNA
Other - Middle Name:R
Other - Last Name:SHEPARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, MED
Mailing Address - Street 1:1413 W HOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1805
Mailing Address - Country:US
Mailing Address - Phone:312-560-9809
Mailing Address - Fax:
Practice Address - Street 1:1413 W HOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1805
Practice Address - Country:US
Practice Address - Phone:312-560-9809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0131121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical