Provider Demographics
NPI:1720407679
Name:HEAD HEART THERAPY
Entity Type:Organization
Organization Name:HEAD HEART THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BUINO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC, CDWF
Authorized Official - Phone:773-351-7101
Mailing Address - Street 1:3759 N RAVENSWOOD
Mailing Address - Street 2:133
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3997
Mailing Address - Country:US
Mailing Address - Phone:773-351-7101
Mailing Address - Fax:773-525-4105
Practice Address - Street 1:3759 N RAVENSWOOD
Practice Address - Street 2:133
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3997
Practice Address - Country:US
Practice Address - Phone:773-351-7101
Practice Address - Fax:773-525-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490148721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty