MEDICARE: ETAPAS THERAPY

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	:	1245192988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETAPAS THERAPY

Provider Business Mailing Address
First Line	:	5401 W LAWRENCE AVE UNIT 30065
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2761
Country	:	US
Telephone Number	:	708-232-6573
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 W LAWRENCE AVE UNIT 30065
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2761
Country	:	US
Telephone Number	:	708-232-6573
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MARIA ISABEL GOMEZ-CZAJA
Credential	:	LCSW
Telephone Number	:	773-988-0795

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/13/2025

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