Provider Demographics
NPI:1629442686
Name:WHITE, SYLVIA P I (LCSW)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:P
Last Name:WHITE
Suffix:I
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 1:1135 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-1147
Mailing Address - Country:US
Mailing Address - Phone:773-483-6462
Mailing Address - Fax:773-483-5259
Practice Address - Street 1:1135 W 69TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-1147
Practice Address - Country:US
Practice Address - Phone:773-483-6462
Practice Address - Fax:773-483-5259
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL1490113891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health