Healthcare Provider Details

I. General information

NPI: 1164366506
Provider Name (Legal Business Name): SYNAPSE BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 LINDEN ST
GLEN ELLYN IL
60137-4010
US

IV. Provider business mailing address

254 LINDEN ST
GLEN ELLYN IL
60137-4010
US

V. Phone/Fax

Practice location:
  • Phone: 630-864-7410
  • Fax: 630-982-1440
Mailing address:
  • Phone: 630-864-7410
  • Fax: 630-982-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHANNON BARTOLUCCI
Title or Position: OWNER
Credential: PMHNP
Phone: 630-864-7410