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General NPI Number Information
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NPI Number | 1023507019
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Entity Type | Organization
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Legal Business Name | CHRONIC ILLNESS PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 2530 CRAWFORD AVE STE 116
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City | EVANSTON
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State | IL
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Zip | 60201-4954
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Country | US
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Telephone | 847-497-8374
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Fax |
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Provider Business Mailing Address
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Address Line | 2530 CRAWFORD AVE STE 116
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City | EVANSTON
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State | IL
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Zip | 60201-4954
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Country | US
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Telephone | 847-497-8374
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Fax |
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Authorized Official
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Title or Position | MANAGING PROVIDER
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Name | STEPHANIE KRISTINE BRENNER
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Credential | LCSW
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Telephone | 847-497-8374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149015344
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License Number State | IL
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