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Organization
MIA DAGOSTINO LLC
Active
Organization
MIA DAGOSTINO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIA TERESA D'AGOSTINO LCSW (OWNER)
(773) 266-8984
Entity
Organization
Contact information
Practice address
60 REVERE DR, SUITE 100, NORTHBROOK, IL 60062-1563
(773) 266-8984
Mailing address
1527 W BARRY AVE, UNIT 1, CHICAGO, IL 60657-3105
(773) 266-8984
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.017535
IL
Other
Enumeration date
09/30/2015
Last updated
09/30/2015
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