| Innerbloom Therapy Practice Pc | |
|
2656 W Montrose Avenue Suite 104 Chicago IL 60618 | |
| (773) 969-6030 | |
| Not Available |
| Full Name | Innerbloom Therapy Practice Pc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2656 W Montrose Avenue, Chicago, Illinois |
| Authorized Official Name and Position | Denise Lynn Gulotta (PRESIDENT) |
| Authorized Official Contact | 7739696030 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innerbloom Therapy Practice Pc 1235 N Clybourn Ave Suite A Box 222 Chicago IL 60610 Ph: (773) 969-6030 | Innerbloom Therapy Practice Pc 2656 W Montrose Avenue Suite 104 Chicago IL 60618 Ph: (773) 969-6030 |
| NPI Number | 1457080301 |
|---|---|
| Provider Enumeration Date | 06/07/2022 |
| Last Update Date | 08/08/2023 |
| Certification Date | 08/08/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457080301 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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