Provider Demographics
NPI:1689029050
Name:SOULU
Entity Type:Organization
Organization Name:SOULU
Other - Org Name:MADRAIGOS MIDWEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-478-6000
Mailing Address - Street 1:3557 W PETERSON AVE #122
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659
Mailing Address - Country:US
Mailing Address - Phone:773-478-6000
Mailing Address - Fax:773-478-6516
Practice Address - Street 1:3557 W PETERSON AVE #122
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659
Practice Address - Country:US
Practice Address - Phone:773-478-6000
Practice Address - Fax:773-478-6516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251V00000XAgenciesVoluntary or CharitableGroup - Single Specialty