Provider Demographics
NPI:1629391065
Name:PITALE, SWATI (PSYD)
Entity type:Individual
Prefix:DR
First Name:SWATI
Middle Name:
Last Name:PITALE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 N SHEFFIELD AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3673
Mailing Address - Country:US
Mailing Address - Phone:773-961-5405
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD
Practice Address - Street 2:SUITE 602
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3606
Practice Address - Country:US
Practice Address - Phone:773-961-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-007537103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical