Provider Demographics
NPI:1689866972
Name:GATY, CORNELIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CORNELIA
Middle Name:
Last Name:GATY
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 1:1020 HULL TER # 2
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3311
Mailing Address - Country:US
Mailing Address - Phone:847-533-1820
Mailing Address - Fax:
Practice Address - Street 1:1020 HULL TER # 2
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3311
Practice Address - Country:US
Practice Address - Phone:847-533-1820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490012471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL393900Medicare PIN