MEDICARE: PIVOT BEHAVIORAL HEALTH, 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	103TH0004X	Health Psychologist

General Provider Information

NPI Number	:	1316800980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIVOT BEHAVIORAL HEALTH, PLLC

Provider Business Mailing Address
First Line	:	611 W BRIAR PL STE 6
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 W BRIAR PL STE 6
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4560
Country	:	US
Telephone Number	:	773-234-1721
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EMERSON EPSTEIN
Credential	:	PHD
Telephone Number	:	773-234-1721

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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