Provider Demographics
NPI:1548653371
Name:HOLMES, CYNTHIA (LCSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 N SHERIDAN RD
Mailing Address - Street 2:#1507
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1958
Mailing Address - Country:US
Mailing Address - Phone:734-834-0491
Mailing Address - Fax:
Practice Address - Street 1:8 S MICHIGAN AVE
Practice Address - Street 2:SUITE 1420
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3357
Practice Address - Country:US
Practice Address - Phone:734-834-0491
Practice Address - Fax:312-757-4257
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490171771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical