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NPI Code Detail

MEDICARE: CATHOLIC CHARITIES OF THE ARCHDIOCESE OF CHICAGO

MEDICARE: CATHOLIC CHARITIES OF THE ARCHDIOCESE OF CHICAGO
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)

General Provider Information

NPI Number : 1609653914
Entity Type Code : Organization
Provider Name (Legal Business Name) : CATHOLIC CHARITIES OF THE ARCHDIOCESE OF CHICAGO
Provider Business Mailing Address
First Line : 721 N. LASALLE ST
Second Line :
City : CHICAGO
State : IL
Zip : 60654
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3110 W ARMITAGE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-3819
Country : US
Telephone Number : 312-655-7725
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : CARLA R GUTIERREZ DOMINGUEZ
Credential : LCSW
Telephone Number : 312-339-3428
Provider Enumeration Date : 09/11/2023
Last Update Date : 09/11/2023

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Directions to “CATHOLIC CHARITIES OF THE ARCHDIOCESE OF CHICAGO ” Practice Location

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