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NPI Code Detail

MEDICARE: SUPERKIDS CHICAGO

MEDICARE: SUPERKIDS 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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1942541305
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPERKIDS CHICAGO
Provider Business Mailing Address
First Line : 3139 N LINCOLN AVE STE 224
Second Line :
City : CHICAGO
State : IL
Zip : 60657-3122
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2441 N KEDZIE BLVD
Second Line : SUITE 1
City : CHICAGO
State : IL
Zip : 60647-2674
Country : US
Telephone Number : 773-662-8088
Fax Number : 773-384-8477
Authorized Official
Title or Position : CEO AND THERAPIST
Name : DANIELLE MARINO
Credential :
Telephone Number : 847-272-8088
Provider Enumeration Date : 03/11/2013
Last Update Date : 03/07/2025

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Directions to “SUPERKIDS CHICAGO ” Practice Location

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