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General NPI Number Information
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NPI Number | 1851758239
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Entity Type | Organization
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Legal Business Name | LEANNA FORTUNATO PSYCHOLOGICAL SERVICES, P.C.
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Dates
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Enumeration Date | 01/15/2016
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Last Update Date | 01/15/2016
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Provider Practice Location Address
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Address Line | 980 N MICHIGAN AVE SUITE 1400
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City | CHICAGO
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State | IL
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Zip | 60611-4501
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Country | US
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Telephone | 312-214-3994
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Fax |
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Provider Business Mailing Address
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Address Line | 980 N MICHIGAN AVE SUITE 1400
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City | CHICAGO
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State | IL
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Zip | 60611-4501
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Country | US
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Telephone | 312-214-3994
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | LEANNA FORTUNATO
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Credential | PH.D.
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Telephone | 734-657-0467
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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 | 071008199
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License Number State | IL
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