Provider Demographics
NPI:1114554722
Name:FOR REAL THERAPY INC
Entity Type:Organization
Organization Name:FOR REAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FABRICE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-888-1681
Mailing Address - Street 1:1951 W SUNNYSIDE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5861
Mailing Address - Country:US
Mailing Address - Phone:954-559-0073
Mailing Address - Fax:
Practice Address - Street 1:1564 N DAMEN AVE STE 208
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2102
Practice Address - Country:US
Practice Address - Phone:773-888-1681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty