Provider Demographics
NPI:1356689939
Name:SULLIVAN, WHITNEY E (LCSW, RDT)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:E
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LCSW, RDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 W TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2833
Mailing Address - Country:US
Mailing Address - Phone:317-695-7534
Mailing Address - Fax:
Practice Address - Street 1:4902 N LAWNDALE AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5665
Practice Address - Country:US
Practice Address - Phone:317-695-7534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0150671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical