MEDICARE: FERMATA PSYCHOTHERAPY, P.C.

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	149.019286	IL

General Provider Information

NPI Number	:	1669964482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERMATA PSYCHOTHERAPY, P.C.

Provider Business Mailing Address
First Line	:	53 W JACKSON BLVD STE 1632
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-3734
Country	:	US
Telephone Number	:	312-520-6096
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 W JACKSON BLVD STE 1450
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-3535
Country	:	US
Telephone Number	:	312-725-6192
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SANTIAGO DELBOY
Credential	:
Telephone Number	:	312-520-6096

Provider Enumeration Date	:	06/06/2018
Last Update Date	:	04/08/2025

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