MEDICARE: REWEAVE THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1114881786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REWEAVE THERAPY PLLC

Provider Business Mailing Address
First Line	:	5006 N WINCHESTER AVE APT 1E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2681
Country	:	US
Telephone Number	:	773-217-5099
Fax Number	:

Provider Business Practice Location Address
First Line	:	5006 N WINCHESTER AVE APT 1E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2681
Country	:	US
Telephone Number	:	773-217-5099
Fax Number	:

Authorized Official
Title or Position	:	MARRIAGE & FAMILY THERAPIST
Name	:	MICHAEL ZETUNE DORFMAN
Credential	:	LMFT
Telephone Number	:	773-217-0599

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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