Healthcare Provider Details

I. General information

NPI: 1881108579
Provider Name (Legal Business Name): BEATA STASZEWSKI LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 N WESTERN AVE STE 406
CHICAGO IL
60622-1774
US

IV. Provider business mailing address

2232 N CLYBOURN AVE FL 3
CHICAGO IL
60614-3193
US

V. Phone/Fax

Practice location:
  • Phone: 312-633-5841
  • Fax: 312-491-5020
Mailing address:
  • Phone: 312-633-5841
  • Fax: 773-269-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180011076
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: