MEDICARE: MOSAIC BRAIN KINTSUGI NEUROPSYCHOLOGY & THERAPY PLACE

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

General Provider Information

NPI Number	:	1548111230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSAIC BRAIN KINTSUGI NEUROPSYCHOLOGY & THERAPY PLACE

Provider Business Mailing Address
First Line	:	4003 PLAINFIELD NAPERVILLE RD STE 209-2
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-4147
Country	:	US
Telephone Number	:	630-793-4552
Fax Number	:	630-358-6799

Provider Business Practice Location Address
First Line	:	4003 PLAINFIELD NAPERVILLE RD STE 209-2
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-4147
Country	:	US
Telephone Number	:	630-793-4552
Fax Number	:	630-358-6799

Authorized Official
Title or Position	:	OWNER AND LICENSED CLINICAL PSYCHOL
Name	:	MONIKA MALINOWSKA
Credential	:	PSY.D
Telephone Number	:	630-770-0305

Provider Enumeration Date	:	02/07/2026
Last Update Date	:	02/07/2026

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