Provider Demographics
NPI:1982193835
Name:NATALIA KACZMAREK LLC
Entity Type:Organization
Organization Name:NATALIA KACZMAREK LLC
Other - Org Name:INDIGO THERAPY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KACZMAREK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-870-0120
Mailing Address - Street 1:900 SKOKIE BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4014
Mailing Address - Country:US
Mailing Address - Phone:312-870-0120
Mailing Address - Fax:
Practice Address - Street 1:900 SKOKIE BLVD STE 115
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4014
Practice Address - Country:US
Practice Address - Phone:312-870-0120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009646261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)