Provider Demographics
NPI:1700441458
Name:PARK BENCH PSYCHOTHERAPY, INC.
Entity Type:Organization
Organization Name:PARK BENCH PSYCHOTHERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LENCIONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-640-9580
Mailing Address - Street 1:1647 N ARTESIAN AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5308
Mailing Address - Country:US
Mailing Address - Phone:630-640-9580
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 500F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7511
Practice Address - Country:US
Practice Address - Phone:630-640-9580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty