| NPI | 1588323331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIS JOSEPH FORMICA Licensed Clinical Psychologist 312-625-7352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2021-12-09 |
| Last Update Date | 2021-12-09 |