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General NPI Number Information
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NPI Number | 1336506484
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Entity Type | Individual
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Provider Name | DOMENICO CARLI
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Gender | Male
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 650 N DEARBORN ST #400
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City | CHICAGO
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State | IL
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Zip | 60654-3873
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Country | US
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Telephone | 312-291-9570
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Fax |
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Provider Business Mailing Address
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Address Line | 650 N DEARBORN ST #400
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City | CHICAGO
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State | IL
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Zip | 60654-3873
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Country | US
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Telephone | 312-191-6570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180004286
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License Number State | IL
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