Healthcare Provider Details

I. General information

NPI: 1467693671
Provider Name (Legal Business Name): CATHERINE HENNESSY PRICE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3139 N LINCOLN AVE STE #210
CHICAGO IL
60657-3114
US

IV. Provider business mailing address

3139 N LINCOLN AVE STE #210
CHICAGO IL
60657-3114
US

V. Phone/Fax

Practice location:
  • Phone: 773-281-8130
  • Fax: 773-281-7150
Mailing address:
  • Phone: 773-281-8130
  • Fax: 773-281-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149-007845
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: