MEDICARE: INSIGHT THERAPY STUDIO 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	:	1568259133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSIGHT THERAPY STUDIO PLLC

Provider Business Mailing Address
First Line	:	3054 N CLIFTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3054 N CLIFTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4334
Country	:	US
Telephone Number	:	312-715-7676
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ELIZABETH DIAZ
Credential	:
Telephone Number	:	312-715-7676

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	05/04/2025

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