Healthcare Provider Details

I. General information

NPI: 1770411696
Provider Name (Legal Business Name): JULIETTE NICOLE CELOZZI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N HALSTED ST
CHICAGO IL
60657-5188
US

IV. Provider business mailing address

2300 N LINCOLN PARK W
CHICAGO IL
60614-3456
US

V. Phone/Fax

Practice location:
  • Phone: 312-376-1665
  • Fax:
Mailing address:
  • Phone: 818-575-0225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number208.011639
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: