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General NPI Number Information
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NPI Number | 1578880050
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Entity Type | Organization
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Legal Business Name | NAPERVILLE-WHEATON THERAPY ASSOCIATES LLC
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 04/26/2010
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Provider Practice Location Address
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Address Line | 1555 NAPERVILLE WHEATON RD STE 104
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City | NAPERVILLE
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State | IL
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Zip | 60563-1557
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Country | US
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Telephone | 630-355-9890
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Fax | 630-469-3562
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Provider Business Mailing Address
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Address Line | 1555 NAPERVILLE WHEATON RD STE 104
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City | NAPERVILLE
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State | IL
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Zip | 60563-1557
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Country | US
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Telephone | 630-355-9890
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Fax | 630-469-3562
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Authorized Official
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Title or Position | LCSW
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Name | CAROLYN L WRIGHT
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Credential | LCSW
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Telephone | 630-355-9890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149002210
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071005052
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License Number State | IL
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