Provider Demographics
NPI:1588172746
Name:SOSTRIN, JULIA GRACE (CADC, LCSW)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:GRACE
Last Name:SOSTRIN
Suffix:
Gender:F
Credentials:CADC, LCSW
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:GRACE
Other - Last Name:SOSTRIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:100 SAUNDERS RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2526
Mailing Address - Country:US
Mailing Address - Phone:847-574-5718
Mailing Address - Fax:
Practice Address - Street 1:100 SAUNDERS RD STE 150
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2526
Practice Address - Country:US
Practice Address - Phone:847-574-5718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0234061041C0700X
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.023406OtherSTATE LCSW