Provider Demographics
NPI:1376603944
Name:GALVIN DELSOL, VEARL DEAN (EDD LCPC)
Entity Type:Individual
Prefix:MRS
First Name:VEARL
Middle Name:DEAN
Last Name:GALVIN DELSOL
Suffix:
Gender:F
Credentials:EDD LCPC
Other - Prefix:MRS
Other - First Name:VEARL
Other - Middle Name:DEAN
Other - Last Name:GALVIN DELSOL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:715 LAKE ST
Mailing Address - Street 2:SUITE 519
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301
Mailing Address - Country:US
Mailing Address - Phone:630-551-4140
Mailing Address - Fax:630-551-4170
Practice Address - Street 1:715 LAKE ST
Practice Address - Street 2:SUITE 519
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301
Practice Address - Country:US
Practice Address - Phone:630-551-4140
Practice Address - Fax:630-551-4170
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0009932407OtherBCBS