MEDICARE: CONNECTION AND BELONGING THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1053099150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECTION AND BELONGING THERAPY PLLC

Provider Business Mailing Address
First Line	:	3058 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5707
Country	:	US
Telephone Number	:	312-927-3726
Fax Number	:

Provider Business Practice Location Address
First Line	:	3058 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5707
Country	:	US
Telephone Number	:	312-927-3726
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	SUSANA ORTEGA
Credential	:	LCSW, PMH-C
Telephone Number	:	312-927-3726

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	08/14/2023

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