MEDICARE: MICHAEL DEVITO LMFT

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	106H00000X	Marriage & Family Therapist	MFC39237	CA
2	106H00000X	Marriage & Family Therapist	16600997	IL

General Provider Information

NPI Number	:	1306902689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DEVITO LMFT

Provider Business Mailing Address
First Line	:	3010 W CORNELIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5606
Country	:	US
Telephone Number	:	415-250-7490
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 W CORNELIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5606
Country	:	US
Telephone Number	:	415-250-7490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	12/20/2018

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Directions to “ MICHAEL DEVITO LMFT” Practice Location

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