| North Shore Resilient Family Llc | |
|
636 Church St Ste 416 Evanston IL 60201-4580 | |
| (847) 461-9731 | |
| Not Available |
| Full Name | North Shore Resilient Family Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 636 Church St Ste 416, Evanston, Illinois |
| Authorized Official Name and Position | Mary Alexandra 'alex Doty (OWNER/ CLINICIAN) |
| Authorized Official Contact | 8474619731 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| North Shore Resilient Family Llc 2636 Prairie Ave Apt A Evanston IL 60201-5743 Ph: (847) 461-9731 | North Shore Resilient Family Llc 636 Church St Ste 416 Evanston IL 60201-4580 Ph: (847) 461-9731 |
| NPI Number | 1891226767 |
|---|---|
| Provider Enumeration Date | 03/23/2017 |
| Last Update Date | 09/21/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891226767 | NPI | - | NPPES |
| 00000000 | Other | N/A |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149-009018 (Illinois) | Primary |
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