Healthcare Provider Details

I. General information

NPI: 1215330048
Provider Name (Legal Business Name): CHICAGO PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 N CLYBOURN AVE STE 300
CHICAGO IL
60614-7395
US

IV. Provider business mailing address

1925 N CLYBOURN AVE STE 300
CHICAGO IL
60614-7395
US

V. Phone/Fax

Practice location:
  • Phone: 773-697-8839
  • Fax:
Mailing address:
  • Phone: 773-697-8839
  • Fax:

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.008925
License Number StateIL

VIII. Authorized Official

Name: DR. CAROLINE BLISS ADELMAN
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 919-265-7070