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General NPI Number Information
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NPI Number | 1841589462
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Entity Type | Organization
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Legal Business Name | CHICAGO CENTER FOR PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 137 N OAK PARK AVE STE 327
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City | OAK PARK
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State | IL
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Zip | 60301-1375
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Country | US
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Telephone | 708-848-0491
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Fax | 708-848-2876
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Provider Business Mailing Address
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Address Line | 137 N OAK PARK AVE STE 327
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City | OAK PARK
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State | IL
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Zip | 60301-1375
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Country | US
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Telephone | 708-848-0491
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MS. NICOLE M REA
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Credential | LCSW
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Telephone | 708-996-0699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-004882
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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