Provider Demographics
NPI:1023849643
Name:LOPEZ-PULLMAN, PATRICIA C (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:C
Last Name:LOPEZ-PULLMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:PATY
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:555 HAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2620
Mailing Address - Country:US
Mailing Address - Phone:312-907-9241
Mailing Address - Fax:
Practice Address - Street 1:450 E 22ND ST STE 158
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6175
Practice Address - Country:US
Practice Address - Phone:630-474-3900
Practice Address - Fax:630-474-3903
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490111631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical