=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699006825
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NICOLETTE PUNTINI, PH.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2010
-----------------------------------------------------
Last Update Date | 01/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 N MICHIGAN AVE SUITE 1924
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60602-3402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-480-6308
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 N MICHIGAN AVE SUITE 1924
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60602-3402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-480-6308
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. NICOLETTE PUNTINI
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 312-480-6308
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 071.003843
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------