Provider Demographics
NPI:1215667787
Name:SCANDINARO COLLECTIVE, PLLC
Entity type:Organization
Organization Name:SCANDINARO COLLECTIVE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCANDINARO
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-702-0772
Mailing Address - Street 1:1440 W TAYLOR ST # 2660
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4623
Mailing Address - Country:US
Mailing Address - Phone:312-702-0772
Mailing Address - Fax:
Practice Address - Street 1:1224 W VANBUREN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607
Practice Address - Country:US
Practice Address - Phone:312-702-0772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty