Organization
PRIVATE PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MAMIE ROBINSON (DIRECTOR OF MENTAL HEALTH)
(773) 383-4149
Entity
Organization
Contact information
Practice address
76 E 89TH PL, CHICAGO, IL 60619-6607
(773) 383-4149
Mailing address
76 E 89TH PL, CHICAGO, IL 60619-6607
(773) 383-4149
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
05/06/2013
Last updated
05/06/2013
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