Healthcare Provider Details

I. General information

NPI: 1972157667
Provider Name (Legal Business Name): MSC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 S HYDE PARK BLVD APT 15E
CHICAGO IL
60615-4265
US

IV. Provider business mailing address

5140 S HYDE PARK BLVD APT 15E
CHICAGO IL
60615-4265
US

V. Phone/Fax

Practice location:
  • Phone: 773-387-3577
  • Fax:
Mailing address:
  • Phone:
  • 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: MARILU SANTA-CRUZ
Title or Position: PRESIDENT
Credential: LCSW
Phone: 733-873-5777