Provider Demographics
NPI:1578965406
Name:GERMAN, LUCILLE
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:
Last Name:GERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LUCILLE
Other - Middle Name:
Other - Last Name:GERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1815 E 93RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3614
Mailing Address - Country:US
Mailing Address - Phone:773-708-3312
Mailing Address - Fax:773-721-0945
Practice Address - Street 1:1815 E 93RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3614
Practice Address - Country:US
Practice Address - Phone:773-708-3312
Practice Address - Fax:773-721-0945
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490117741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical