Provider Demographics
NPI:1841990983
Name:ROSARIUM PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:ROSARIUM PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SHIVER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-484-0329
Mailing Address - Street 1:3742 N MAGNOLIA AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3846
Mailing Address - Country:US
Mailing Address - Phone:773-484-0329
Mailing Address - Fax:
Practice Address - Street 1:3742 N MAGNOLIA AVE APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3846
Practice Address - Country:US
Practice Address - Phone:773-484-0329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty