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General NPI Number Information
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NPI Number | 1407527799
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Entity Type | Organization
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Legal Business Name | EMERALD PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 09/25/2021
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Last Update Date | 09/25/2021
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Provider Practice Location Address
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Address Line | 75 EASTWOOD DR
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City | DEERFIELD
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State | IL
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Zip | 60015-5007
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Country | US
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Telephone | 312-246-1440
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Fax |
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Provider Business Mailing Address
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Address Line | 75 EASTWOOD DR
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City | DEERFIELD
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State | IL
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Zip | 60015-5007
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Country | US
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Telephone | 312-246-1440
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Fax |
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Authorized Official
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Title or Position | OWNER OF PRACTICE
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Name | ALLISON STEIN
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Credential | LCSW
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Telephone | 312-246-1440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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