Healthcare Provider Details

I. General information

NPI: 1407068331
Provider Name (Legal Business Name): GERALDINE KATZ-ATKIN P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E LIBERTY DR APT 605
WHEATON IL
60187-5428
US

IV. Provider business mailing address

255 E LIBERTY DR APT 605
WHEATON IL
60187-5428
US

V. Phone/Fax

Practice location:
  • Phone: 630-269-3726
  • Fax:
Mailing address:
  • Phone: 630-269-3726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149003754
License Number StateIL

VIII. Authorized Official

Name: MS. GERALDINE JOYCE KATZ-ATKIN
Title or Position: OWNER
Credential: LCSW
Phone: 630-942-9370