Healthcare Provider Details

I. General information

NPI: 1508563040
Provider Name (Legal Business Name): SEVERO THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 W CHICAGO AVE STE 207
CHICAGO IL
60642-5231
US

IV. Provider business mailing address

1407 W CHICAGO AVE STE 207
CHICAGO IL
60642-5231
US

V. Phone/Fax

Practice location:
  • Phone: 312-319-4650
  • Fax: 502-499-4431
Mailing address:
  • Phone: 312-319-4650
  • Fax: 502-499-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINA SEVERO
Title or Position: OWNER/LCSW
Credential: LCSW
Phone: 502-627-0093