Healthcare Provider Details

I. General information

NPI: 1578880050
Provider Name (Legal Business Name): NAPERVILLE-WHEATON THERAPY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 NAPERVILLE WHEATON RD STE 104
NAPERVILLE IL
60563-1557
US

IV. Provider business mailing address

1555 NAPERVILLE WHEATON RD STE 104
NAPERVILLE IL
60563-1557
US

V. Phone/Fax

Practice location:
  • Phone: 630-355-9890
  • Fax: 630-469-3562
Mailing address:
  • Phone: 630-355-9890
  • Fax: 630-469-3562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071005052
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149002210
License Number StateIL

VIII. Authorized Official

Name: CAROLYN L WRIGHT
Title or Position: LCSW
Credential: LCSW
Phone: 630-355-9890