Provider Demographics
NPI:1023886892
Name:INTERCONNECTED PSYCHOTHERAPY, PLLC
Entity type:Organization
Organization Name:INTERCONNECTED PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:AMARO
Authorized Official - Last Name:LOPEZ MASON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-357-5960
Mailing Address - Street 1:2501 CHATHAM RD # 8143
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4188
Mailing Address - Country:US
Mailing Address - Phone:773-357-5960
Mailing Address - Fax:
Practice Address - Street 1:1500 SANDSTONE DR APT 217
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5924
Practice Address - Country:US
Practice Address - Phone:773-357-5960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty