Healthcare Provider Details

I. General information

NPI: 1184450843
Provider Name (Legal Business Name): NAMASA THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 WESTHAVEN CIR
GENEVA IL
60134-3971
US

IV. Provider business mailing address

250 WESTHAVEN CIR
GENEVA IL
60134-3971
US

V. Phone/Fax

Practice location:
  • Phone: 630-917-0552
  • Fax:
Mailing address:
  • Phone: 630-917-0552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENNISE SERUR DEMITRO
Title or Position: OWNER-PSYCHOTHERAPIST
Credential: LCSW
Phone: 630-917-0552