Provider Demographics
NPI:1982198891
Name:MOSAIC GROUP LLC
Entity Type:Organization
Organization Name:MOSAIC GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:VYAZOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-799-9351
Mailing Address - Street 1:8300 CALLIE AVE UNIT 405
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3722
Mailing Address - Country:US
Mailing Address - Phone:312-799-9351
Mailing Address - Fax:
Practice Address - Street 1:8300 CALLIE AVE UNIT 405
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3722
Practice Address - Country:US
Practice Address - Phone:312-799-9351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL348827170001Medicaid