MEDICARE: URBAN WELLNESS, LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	1041C0700X	Clinical Social Worker
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1942565353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URBAN WELLNESS, LTD.

Provider Business Mailing Address
First Line	:	6601 N AVONDALE AVE
Second Line	:	101
City	:	CHICAGO
State	:	IL
Zip	:	60631-1572
Country	:	US
Telephone Number	:	773-774-4444
Fax Number	:	773-774-4447

Provider Business Practice Location Address
First Line	:	6601 N AVONDALE AVE STE 101
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-1567
Country	:	US
Telephone Number	:	773-774-4444
Fax Number	:	773-774-4447

Authorized Official
Title or Position	:	OWNER
Name	:	MAUREEN WERRBACH
Credential	:
Telephone Number	:	773-774-4444

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	03/17/2018

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Directions to “URBAN WELLNESS, LTD. ” Practice Location

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