Provider Demographics
NPI:1720113038
Name:CORCORAN, SYLVIA (LCSW, CADC, MCED)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:LCSW, CADC, MCED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 MAPLE AVE
Mailing Address - Street 2:APT. 3B
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-4204
Mailing Address - Country:US
Mailing Address - Phone:847-864-0042
Mailing Address - Fax:
Practice Address - Street 1:618 LIBRARY PL
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-2908
Practice Address - Country:US
Practice Address - Phone:847-733-4300
Practice Address - Fax:847-733-0390
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22293101YA0400X
IL149.0118951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)