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General NPI Number Information
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NPI Number | 1093515991
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Entity Type | Organization
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Legal Business Name | SYNERGY RELATIONAL THERAPY
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 1 E ERIE ST # 525-4219
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City | CHICAGO
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State | IL
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Zip | 60611-2740
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Country | US
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Telephone | 773-530-1354
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Fax |
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Provider Business Mailing Address
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Address Line | 2845 AUXPLAINES AVE
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City | RIVER GROVE
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State | IL
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Zip | 60171-1407
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | NICOLE FERNANDEZ
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Credential | MS, LMFT
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Telephone | 773-936-5844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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