Provider Demographics
NPI:1083060537
Name:LUNARE WELLNESS LLC
Entity Type:Organization
Organization Name:LUNARE WELLNESS LLC
Other - Org Name:LUNARE WELLNESS SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ZERBST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-797-2238
Mailing Address - Street 1:1428 W JARVIS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626
Mailing Address - Country:US
Mailing Address - Phone:720-273-6461
Mailing Address - Fax:
Practice Address - Street 1:725 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2283
Practice Address - Country:US
Practice Address - Phone:720-273-6461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0162971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty