Healthcare Provider Details

I. General information

NPI: 1902616691
Provider Name (Legal Business Name): BESPOKE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7366 N LINCOLN AVE STE 205-206
LINCOLNWOOD IL
60712-1708
US

IV. Provider business mailing address

2642 W FARRAGUT AVE UNIT 2
CHICAGO IL
60625-3308
US

V. Phone/Fax

Practice location:
  • Phone: 773-682-4903
  • Fax:
Mailing address:
  • Phone: 773-682-4903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. POOJA AGARWAL
Title or Position: PRESIDENT
Credential: MD
Phone: 773-682-4903