Provider Demographics
NPI:1821525445
Name:CAMILA SALVISBERG LLC
Entity Type:Organization
Organization Name:CAMILA SALVISBERG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMILA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:SALVISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:872-529-0607
Mailing Address - Street 1:500 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1042
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3777
Mailing Address - Country:US
Mailing Address - Phone:872-529-0607
Mailing Address - Fax:
Practice Address - Street 1:500 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1042
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3777
Practice Address - Country:US
Practice Address - Phone:872-529-0607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009667101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty