MEDICARE: SOLWAY PSYCHOLOGY LLC

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	103T00000X	Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1184017394	OTHER		NPPES

General Provider Information

NPI Number	:	1083191753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLWAY PSYCHOLOGY LLC

Provider Business Mailing Address
First Line	:	4424 N RAVENSWOOD AVE APT A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5803
Country	:	US
Telephone Number	:	678-765-9294
Fax Number	:

Provider Business Practice Location Address
First Line	:	4424 N RAVENSWOOD AVE APT A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5803
Country	:	US
Telephone Number	:	678-765-9294
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. SETH SOLWAY
Credential	:	PSY.D.
Telephone Number	:	860-287-0948

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	05/10/2021

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Directions to “SOLWAY PSYCHOLOGY LLC ” Practice Location

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