Provider Demographics
NPI:1396450573
Name:CENTER FOR COMMUNITY AND PSYCHOTHERAPY
Entity type:Organization
Organization Name:CENTER FOR COMMUNITY AND PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:310-722-9759
Mailing Address - Street 1:714 W BRIAR PL APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-9783
Mailing Address - Country:US
Mailing Address - Phone:310-722-9759
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 707
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7706
Practice Address - Country:US
Practice Address - Phone:773-830-4251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty