Provider Demographics
NPI:1437251980
Name:MERCOLA, LOREN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LOREN
Middle Name:
Last Name:MERCOLA
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 1:1560 N SANDBURG TER APT 2308
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7720
Mailing Address - Country:US
Mailing Address - Phone:312-806-8880
Mailing Address - Fax:
Practice Address - Street 1:500 N MICHIGAN AVE STE 600
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3754
Practice Address - Country:US
Practice Address - Phone:312-806-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL16488101YA0400X
IL15339341041S0200X
IL1490078101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364123208OtherTAX ID FOR S-CORP