MEDICARE: JOANNE T MARENGO PH.D.

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	103TC0700X	Clinical Psychologist	071-003235	IL

General Provider Information

NPI Number	:	1467445684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE T MARENGO PH.D.

Provider Business Mailing Address
First Line	:	111 N WABASH AVE
Second Line	:	SUITE 1204
City	:	CHICAGO
State	:	IL
Zip	:	60602-1903
Country	:	US
Telephone Number	:	312-782-5123
Fax Number	:	773-549-3884

Provider Business Practice Location Address
First Line	:	111 N WABASH AVE
Second Line	:	SUITE 1204
City	:	CHICAGO
State	:	IL
Zip	:	60602-1903
Country	:	US
Telephone Number	:	312-782-5123
Fax Number	:	773-549-3884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	03/16/2022

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