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General NPI Number Information
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NPI Number | 1932950177
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Entity Type | Organization
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Legal Business Name | CONNECT PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 03/27/2024
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 525 W DEMING PL APT 218
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City | CHICAGO
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State | IL
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Zip | 60614-5902
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Country | US
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Telephone | 303-552-7696
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Fax |
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Provider Business Mailing Address
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Address Line | 680 N LAKE SHORE DR STE 110-1496
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City | CHICAGO
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State | IL
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Zip | 60611-4546
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Country | US
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Telephone | 708-803-2682
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MARY EMMA COOK
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Credential | LCSW
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Telephone | 708-803-2682
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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 |
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License Number State |
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