Provider Demographics
NPI:1790476497
Name:COLLABORATIVE CARE PSYCHOTHERAPY
Entity Type:Organization
Organization Name:COLLABORATIVE CARE PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:630-742-0408
Mailing Address - Street 1:862 W ROSCOE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7154
Mailing Address - Country:US
Mailing Address - Phone:630-742-0408
Mailing Address - Fax:
Practice Address - Street 1:862 W ROSCOE ST APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-7154
Practice Address - Country:US
Practice Address - Phone:872-216-2819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty