Provider Demographics
NPI:1235881921
Name:SULLIVAN, TERESA (LCSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:SULLIVAN
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 1:3759 N RAVENSWOOD AVE STE 226C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4088
Mailing Address - Country:US
Mailing Address - Phone:708-576-1536
Mailing Address - Fax:
Practice Address - Street 1:3759 N RAVENSWOOD AVE STE 226C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4088
Practice Address - Country:US
Practice Address - Phone:708-576-1536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.024466104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker