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General NPI Number Information
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NPI Number | 1396450573
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Entity Type | Organization
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Legal Business Name | CENTER FOR COMMUNITY AND PSYCHOTHERAPY
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 155 N MICHIGAN AVE STE 707
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City | CHICAGO
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State | IL
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Zip | 60601-7706
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Country | US
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Telephone | 773-830-4251
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Fax |
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Provider Business Mailing Address
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Address Line | 714 W BRIAR PL APT 3
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City | CHICAGO
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State | IL
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Zip | 60657-9783
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Country | US
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Telephone | 310-722-9759
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. IRINA RIVERA
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Credential | CP
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Telephone | 310-722-9759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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