Provider Demographics
NPI:1942565353
Name:URBAN WELLNESS, LTD.
Entity Type:Organization
Organization Name:URBAN WELLNESS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WERRBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-774-4444
Mailing Address - Street 1:6601 N AVONDALE AVE
Mailing Address - Street 2:101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1572
Mailing Address - Country:US
Mailing Address - Phone:773-774-4444
Mailing Address - Fax:773-774-4447
Practice Address - Street 1:6601 N AVONDALE AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1567
Practice Address - Country:US
Practice Address - Phone:773-774-4444
Practice Address - Fax:773-774-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty