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General NPI Number Information
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NPI Number | 1942541305
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Entity Type | Organization
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Legal Business Name | SUPERKIDS CHICAGO
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Dates
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Enumeration Date | 03/11/2013
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 2441 N KEDZIE BLVD SUITE 1
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City | CHICAGO
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State | IL
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Zip | 60647-2674
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Country | US
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Telephone | 773-662-8088
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Fax | 773-384-8477
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Provider Business Mailing Address
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Address Line | 3139 N LINCOLN AVE STE 224
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City | CHICAGO
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State | IL
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Zip | 60657-3122
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO AND THERAPIST
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Name | DANIELLE MARINO
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Credential |
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Telephone | 847-272-8088
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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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