Provider Demographics
NPI:1568598563
Name:QUILTY, LORI JENNIFER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:JENNIFER
Last Name:QUILTY
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 1:1809 N NEWCASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3313
Mailing Address - Country:US
Mailing Address - Phone:312-213-1409
Mailing Address - Fax:
Practice Address - Street 1:4055 W PETERSON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6182
Practice Address - Country:US
Practice Address - Phone:312-213-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical