Organization
LOGAN SQUARE COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK THOMAS SCIARRINO PSYD (PRESIDENT, LICENSED PSYCHOLOGIST)
(773) 245-3725
Entity
Organization
Contact information
Practice address
2724 N KEDZIE AVE, CHICAGO, IL 60647-1514
(773) 245-3725
(773) 453-7258
Mailing address
2724 N KEDZIE AVE, CHICAGO, IL 60647-1514
(773) 245-3725
(773) 453-7258
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071008195
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1861763914
ORGANIZATION PRESIDENT AND SOLE PROVIDER'S RENDERING NPI
—
Enumeration date
07/15/2016
Last updated
08/15/2016
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