Healthcare Provider Details

I. General information

NPI: 1780138792
Provider Name (Legal Business Name): NEW REFLECTION CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29W335 RENOUF DR
WARRENVILLE IL
60555-2116
US

IV. Provider business mailing address

29W335 RENOUF DR
WARRENVILLE IL
60555-2116
US

V. Phone/Fax

Practice location:
  • Phone: 630-346-9266
  • Fax:
Mailing address:
  • Phone: 630-346-9266
  • 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: MRS. FRANCOISE LORRAINE MASTROIANNI
Title or Position: PSYCHOTHERAPIST
Credential: MS
Phone: 630-346-9266