Provider Demographics
NPI:1912697202
Name:LYNN, SOFIA MARIANA (LCPC, CADC)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:MARIANA
Last Name:LYNN
Suffix:
Gender:
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 N PINE GROVE AVE APT 1614
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5508
Mailing Address - Country:US
Mailing Address - Phone:724-710-1071
Mailing Address - Fax:
Practice Address - Street 1:1700 W IRVING PARK RD STE 301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2462
Practice Address - Country:US
Practice Address - Phone:312-248-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL37433101YA0400X
IL178.018975101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)