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NPI Code Detail

MEDICARE: CHICAGO CITY OF

MEDICARE: CHICAGO CITY OF
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)IL

General Provider Information

NPI Number : 1225020456
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHICAGO CITY OF
Provider Business Mailing Address
First Line : 333 S STATE ST
Second Line : #200 CHICAGO DEPARTMENT OF PUBLIC HEALTH
City : CHICAGO
State : IL
Zip : 60604-3900
Country : US
Telephone Number : 312-747-9545
Fax Number : 312-747-9398
Provider Business Practice Location Address
First Line : 1105 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60612-4146
Country : US
Telephone Number : 312-746-5905
Fax Number : 312-746-5015
Authorized Official
Title or Position : MENTAL HEALTH DIRECTOR
Name : MRS. MAMIE POWELL-ROBINSON
Credential :
Telephone Number : 312-745-4696
Provider Enumeration Date : 08/15/2005
Last Update Date : 10/28/2021

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Directions to “CHICAGO CITY OF ” Practice Location

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