Provider Demographics
NPI:1598279333
Name:SOCIOSECURE TECH INC
Entity Type:Organization
Organization Name:SOCIOSECURE TECH INC
Other - Org Name:MINDTUDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:NATARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-323-1758
Mailing Address - Street 1:671 W STREAMWOOD BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-2393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:671 W STREAMWOOD BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-2393
Practice Address - Country:US
Practice Address - Phone:847-323-1758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010765101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty