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General NPI Number Information
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NPI Number | 1437558715
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Entity Type | Organization
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Legal Business Name | MARLA VANNUCCI PHD & ASSOCIATES
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Dates
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Enumeration Date | 08/22/2014
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Last Update Date | 08/22/2014
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE SUITE 1212
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City | CHICAGO
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State | IL
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Zip | 60602-3402
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Country | US
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Telephone | 773-412-0872
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Fax |
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Provider Business Mailing Address
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Address Line | 4831 N TRIPP AVE
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City | CHICAGO
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State | IL
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Zip | 60630-2720
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. MARLA VANNUCCI
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Credential | PHD
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Telephone | 773-412-0872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071006033
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License Number State | IL
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