MEDICARE: TARA SALVIATO PSYCHOTHERAPY, 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1326897257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARA SALVIATO PSYCHOTHERAPY, PLLC

Provider Business Mailing Address
First Line	:	360 W ILLINOIS ST APT 3C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-5248
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 W ILLINOIS ST APT 3C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-5248
Country	:	US
Telephone Number	:	231-343-5499
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TARA SALVIATO
Credential	:	LCSW
Telephone Number	:	231-343-5499

Provider Enumeration Date	:	05/14/2024
Last Update Date	:	05/14/2024

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