Provider Demographics
NPI:1891751236
Name:GUPTA, SONALI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SONALI
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 N. STETSON
Mailing Address - Street 2:3620 PRUDENTIAL PLAZA II,
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:773-732-6219
Mailing Address - Fax:
Practice Address - Street 1:180 N. STETSON
Practice Address - Street 2:3260 PRUDENTIAL PLAZA II,
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601
Practice Address - Country:US
Practice Address - Phone:773-732-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007789103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA715690000OtherMAGELLAN
VA89130028OtherCAREFIRST BCBS
VA010108845Medicaid
VA293990OtherAMERIGROUP
VA188036OtherANTHEM