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General NPI Number Information
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NPI Number | 1497333991
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Entity Type | Organization
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Legal Business Name | HEART & MIND THERAPY, PLLC
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 345 SHERIDAN RD
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-5336
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Country | US
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Telephone | 773-580-5198
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Fax |
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Provider Business Mailing Address
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Address Line | 345 SHERIDAN RD
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-5336
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Country | US
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Telephone | 773-580-5198
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | DR. PAULA T. DICANIO
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Credential | PH.D.
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Telephone | 773-580-5198
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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 |
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License Number State |
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