| NPI | 1376202804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOFIA CARLEEN JIMENEZ Clinical Psychologist/Sole Member 773-946-0993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Enumeration Date | 2021-12-13 |
| Last Update Date | 2021-12-13 |