Provider Demographics
NPI:1245532951
Name:HANTMAN, RUCHIRA GULATI (MA,MS, LCSW)
Entity type:Individual
Prefix:
First Name:RUCHIRA
Middle Name:GULATI
Last Name:HANTMAN
Suffix:
Gender:F
Credentials:MA,MS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 N LASALLE STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4510
Mailing Address - Country:US
Mailing Address - Phone:312-893-7108
Mailing Address - Fax:
Practice Address - Street 1:451 N LA SALLE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-4510
Practice Address - Country:US
Practice Address - Phone:312-893-7108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IL149.0171761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker