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General NPI Number Information
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NPI Number | 1790371847
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Entity Type | Organization
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Legal Business Name | DELVE PSYCHOTHERAPY OF CHICAGO
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Dates
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Enumeration Date | 12/14/2020
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Last Update Date | 05/02/2024
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Provider Practice Location Address
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Address Line | 1340 W ROSEDALE AVE # 1
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City | CHICAGO
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State | IL
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Zip | 60660-3438
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Country | US
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Telephone | 773-234-1463
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Fax |
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Provider Business Mailing Address
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Address Line | 6301 N SHERIDAN RD APT 23K
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City | CHICAGO
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State | IL
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Zip | 60660-5701
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Country | US
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Telephone | 773-234-1463
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE AND CLINICAL DIRECTOR
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Name | DR. ADAM FOMINAYA
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Credential | PHD, LCP
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Telephone | 773-234-1463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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