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NPI Code Detail

MEDICARE: ARTESIAN COLLABORATIVE, LLC

MEDICARE: ARTESIAN COLLABORATIVE, 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
11041C0700XClinical Social Worker
2106H00000XMarriage & Family Therapist
3103TC0700XClinical Psychologist071008056IL

General Provider Information

NPI Number : 1487170007
Entity Type Code : Organization
Provider Name (Legal Business Name) : ARTESIAN COLLABORATIVE, LLC
Provider Business Mailing Address
First Line : 1402 N ARTESIAN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60622-1703
Country : US
Telephone Number : 408-802-3968
Fax Number :
Provider Business Practice Location Address
First Line : 77 W WASHINGTON ST STE 1500
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3219
Country : US
Telephone Number : 773-980-9679
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. SUNITHA RACHEL CHANDY
Credential : PSY.D.
Telephone Number : 773-980-9679
Provider Enumeration Date : 08/15/2017
Last Update Date : 07/19/2022

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Directions to “ARTESIAN COLLABORATIVE, LLC ” Practice Location

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