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General NPI Number Information
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NPI Number | 1053812149
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Entity Type | Organization
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Legal Business Name | SHE IS STRONG AND MINDFUL
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1300 W BELMONT AVE STE 209
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City | CHICAGO
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State | IL
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Zip | 60657-3284
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Country | US
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Telephone | 312-279-8870
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Fax |
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Provider Business Mailing Address
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Address Line | 2711 N KENMORE AVE APT F1
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City | CHICAGO
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State | IL
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Zip | 60614-1376
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Country | US
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Telephone | 217-274-8901
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPSIT
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Name | LORENA S RAMOS
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Credential | MA, MSW, LCSW
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Telephone | 312-279-8870
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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 | 149019412
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License Number State | IL
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