Provider Demographics
NPI:1417789843
Name:CITRINE HEALING PLLC
Entity type:Organization
Organization Name:CITRINE HEALING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THEARPIST
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIETRUSZKA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:217-622-9780
Mailing Address - Street 1:5364 N NOTTINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1953
Mailing Address - Country:US
Mailing Address - Phone:217-622-9780
Mailing Address - Fax:
Practice Address - Street 1:5364 N NOTTINGHAM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1953
Practice Address - Country:US
Practice Address - Phone:217-622-9780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty