1790371847 NPI number — DELVE PSYCHOTHERAPY OF CHICAGO

Table of content: (NPI 1790371847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790371847 NPI number — DELVE PSYCHOTHERAPY OF CHICAGO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELVE PSYCHOTHERAPY OF CHICAGO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790371847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6301 N SHERIDAN RD APT 23K
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60660-5701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-234-1463
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1340 W ROSEDALE AVE # 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60660-3438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-234-1463
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2020

Additional Information

Authorized Official

Authorized Official Last Name:
FOMINAYA
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE AND CLINICAL DIRECTOR
Authorized Official Telephone Number:
773-234-1463

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com