Provider Demographics
NPI:1710476403
Name:PIVOT COLLABORATIVE LLC
Entity Type:Organization
Organization Name:PIVOT COLLABORATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARTOLI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-515-2221
Mailing Address - Street 1:5614 N RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4825
Mailing Address - Country:US
Mailing Address - Phone:312-515-2221
Mailing Address - Fax:
Practice Address - Street 1:1525 E 53RD ST STE 516-4
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4572
Practice Address - Country:US
Practice Address - Phone:312-515-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490166551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty