Healthcare Provider Details

I. General information

NPI: 1073243069
Provider Name (Legal Business Name): RECONNECT PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1658 N MILWAUKEE AVE # 100-1402
CHICAGO IL
60647-6905
US

IV. Provider business mailing address

1658 N MILWAUKEE AVE # 100-1402
CHICAGO IL
60647-6905
US

V. Phone/Fax

Practice location:
  • Phone: 787-486-4440
  • Fax:
Mailing address:
  • Phone: 312-380-9041
  • Fax: 872-250-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PABLO PAGAN-RIVERA
Title or Position: CEO
Credential: PSYD
Phone: 787-486-4440