Provider Demographics
NPI:1366609505
Name:FORTUNATO, JOSEPH P (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:P
Last Name:FORTUNATO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N WABASH AVE
Mailing Address - Street 2:#2608
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5670
Mailing Address - Country:US
Mailing Address - Phone:312-828-0541
Mailing Address - Fax:
Practice Address - Street 1:405 N WABASH AVE
Practice Address - Street 2:#2608
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5670
Practice Address - Country:US
Practice Address - Phone:312-828-0541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004539103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical