Provider Demographics
NPI:1285326264
Name:ANIMA PSYCHOTHERAPY
Entity type:Organization
Organization Name:ANIMA PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MIMOZA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALOJ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:508-425-9124
Mailing Address - Street 1:1819 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4638
Mailing Address - Country:US
Mailing Address - Phone:508-425-9124
Mailing Address - Fax:
Practice Address - Street 1:1819 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4638
Practice Address - Country:US
Practice Address - Phone:508-425-9124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health