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General NPI Number Information
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NPI Number | 1023886892
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Entity Type | Organization
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Legal Business Name | INTERCONNECTED PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 1500 SANDSTONE DR APT 217
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City | WHEELING
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State | IL
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Zip | 60090-5924
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Country | US
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Telephone | 773-357-5960
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD # 8143
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 773-357-5960
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST/OWNER
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Name | MARINA AMARO LOPEZ MASON
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Credential | LCPC
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Telephone | 773-357-5960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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