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General NPI Number Information
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NPI Number | 1588052831
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Entity Type | Organization
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Legal Business Name | CENTER FOR BEHAVIORAL MEDICINE
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Dates
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Enumeration Date | 01/08/2015
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Last Update Date | 01/08/2015
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Provider Practice Location Address
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Address Line | 25 E WASHINGTON ST SUITE 1225
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City | CHICAGO
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State | IL
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Zip | 60602-1708
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Country | US
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Telephone | 312-569-0285
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Fax | 312-245-3124
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Provider Business Mailing Address
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Address Line | 25 E WASHINGTON ST SUITE 1225
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City | CHICAGO
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State | IL
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Zip | 60602-1708
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Country | US
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Telephone | 312-569-0285
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Fax | 312-245-3124
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Authorized Official
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Title or Position | CO-DIRECTOR
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Name | SARA BUXTON
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Credential |
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Telephone | 312-569-0285
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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 | 149017177
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License Number State | IL
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