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General NPI Number Information
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NPI Number | 1114881786
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Entity Type | Organization
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Legal Business Name | REWEAVE THERAPY PLLC
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 5006 N WINCHESTER AVE APT 1E
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City | CHICAGO
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State | IL
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Zip | 60640-2681
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Country | US
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Telephone | 773-217-5099
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Fax |
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Provider Business Mailing Address
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Address Line | 5006 N WINCHESTER AVE APT 1E
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City | CHICAGO
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State | IL
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Zip | 60640-2681
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Country | US
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Telephone | 773-217-5099
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Fax |
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Authorized Official
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Title or Position | MARRIAGE & FAMILY THERAPIST
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Name | MICHAEL ZETUNE DORFMAN
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Credential | LMFT
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Telephone | 773-217-0599
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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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