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General NPI Number Information
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NPI Number | 1215667787
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Entity Type | Organization
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Legal Business Name | SCANDINARO COLLECTIVE, PLLC
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Dates
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Enumeration Date | 06/16/2022
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 1224 W VANBUREN ST
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City | CHICAGO
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State | IL
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Zip | 60607
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Country | US
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Telephone | 312-702-0772
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 W TAYLOR ST # 2660
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City | CHICAGO
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State | IL
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Zip | 60607-4623
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Country | US
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Telephone | 312-702-0772
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | JACLYN M SCANDINARO
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Credential | LCPC
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Telephone | 312-702-0772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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