Provider Demographics
NPI:1053836585
Name:GULOTTA, DENISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:GULOTTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 N CLYBOURN AVE STE A222
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2451
Mailing Address - Country:US
Mailing Address - Phone:773-969-6030
Mailing Address - Fax:312-680-0660
Practice Address - Street 1:2656 W MONTROSE AVE STE 104
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1557
Practice Address - Country:US
Practice Address - Phone:773-969-6030
Practice Address - Fax:313-680-0660
Is Sole Proprietor?:No
Enumeration Date:2017-08-05
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0168341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical