Provider Demographics
NPI:1558754226
Name:SOTOLOFF, ELLEN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:
Last Name:SOTOLOFF
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4217
Mailing Address - Country:US
Mailing Address - Phone:847-251-1046
Mailing Address - Fax:847-789-7172
Practice Address - Street 1:495 CENTRAL AVE
Practice Address - Street 2:STE 203
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3044
Practice Address - Country:US
Practice Address - Phone:847-251-1046
Practice Address - Fax:847-789-7172
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.005517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health