Healthcare Provider Details

I. General information

NPI: 1245192988
Provider Name (Legal Business Name): ETAPAS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 W LAWRENCE AVE UNIT 30065
CHICAGO IL
60630-2761
US

IV. Provider business mailing address

5401 W LAWRENCE AVE UNIT 30065
CHICAGO IL
60630-2761
US

V. Phone/Fax

Practice location:
  • Phone: 708-232-6573
  • Fax:
Mailing address:
  • Phone: 708-232-6573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARIA ISABEL GOMEZ-CZAJA
Title or Position: SOCIAL WORKER
Credential: LCSW
Phone: 773-988-0795