Healthcare Provider Details

I. General information

NPI: 1073377396
Provider Name (Legal Business Name): ELIZABETH FOTOPOULOS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24W788 75TH ST
NAPERVILLE IL
60565-1684
US

IV. Provider business mailing address

24W788 75TH ST
NAPERVILLE IL
60565-1684
US

V. Phone/Fax

Practice location:
  • Phone: 630-881-5564
  • Fax:
Mailing address:
  • Phone: 630-881-5564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH FOTOPOULOS
Title or Position: MANAGER
Credential:
Phone: 630-881-5564