Provider Demographics
NPI:1629453279
Name:PROACTIVE PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:PROACTIVE PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRONE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-987-8679
Mailing Address - Street 1:630 W WRIGHTWOOD AVE
Mailing Address - Street 2:5E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6266
Mailing Address - Country:US
Mailing Address - Phone:847-987-8679
Mailing Address - Fax:
Practice Address - Street 1:630 W WRIGHTWOOD AVE
Practice Address - Street 2:5E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6266
Practice Address - Country:US
Practice Address - Phone:847-987-8679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0177521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty