MEDICARE: SOMA COUNSELING CENTER, 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1619611902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMA COUNSELING CENTER, PLLC

Provider Business Mailing Address
First Line	:	1507 N MILWAUKEE AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2009
Country	:	US
Telephone Number	:	312-298-9060
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 N MILWAUKEE AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2009
Country	:	US
Telephone Number	:	646-276-4825
Fax Number	:	312-896-9396

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CAMILA A RICHMOND
Credential	:	LCSW
Telephone Number	:	312-298-9060

Provider Enumeration Date	:	04/23/2022
Last Update Date	:	04/18/2026

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