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General NPI Number Information
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NPI Number | 1710476403
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Entity Type | Organization
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Legal Business Name | PIVOT COLLABORATIVE LLC
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 1525 E 53RD ST STE 516-4
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City | CHICAGO
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State | IL
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Zip | 60615-4572
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Country | US
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Telephone | 312-515-2221
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Fax |
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Provider Business Mailing Address
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Address Line | 5614 N RICHMOND ST
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City | CHICAGO
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State | IL
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Zip | 60659-4825
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Country | US
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Telephone | 312-515-2221
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LINDA S BARTOLI
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Credential | LCSW
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Telephone | 312-515-2221
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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 | 149016655
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License Number State | IL
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