Provider Demographics
NPI:1801336441
Name:EMILY EDELMAN PSYCHOTHERAPY, AN ILLINOIS CORPORATION
Entity type:Organization
Organization Name:EMILY EDELMAN PSYCHOTHERAPY, AN ILLINOIS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-406-9181
Mailing Address - Street 1:2100 S MARSHALL BLVD
Mailing Address - Street 2:APT 804
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3679
Mailing Address - Country:US
Mailing Address - Phone:773-406-9181
Mailing Address - Fax:
Practice Address - Street 1:2100 S MARSHALL BLVD
Practice Address - Street 2:APT 804
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3679
Practice Address - Country:US
Practice Address - Phone:773-406-9181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.012940305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization