Provider Demographics
NPI:1467163105
Name:LOVELESS, LUCIEN SIRIUS (LSW)
Entity Type:Individual
Prefix:
First Name:LUCIEN
Middle Name:SIRIUS
Last Name:LOVELESS
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:ALLEN
Other - Last Name:THOMAS
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:541 W WELLINGTON AVE APT 59
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5484
Mailing Address - Country:US
Mailing Address - Phone:669-225-1611
Mailing Address - Fax:
Practice Address - Street 1:3047 N LINCOLN AVE UNIT 400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4274
Practice Address - Country:US
Practice Address - Phone:773-494-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1098861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical