| Crescent Moon Therapy, Llc | |
|
1123 Fortuna Ave Park Ridge IL 60068-1956 | |
| (847) 975-5128 | |
| Not Available |
| Full Name | Crescent Moon Therapy, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1123 Fortuna Ave, Park Ridge, Illinois |
| Authorized Official Name and Position | Stephanie Defilippis (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 8479755128 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crescent Moon Therapy, Llc 1123 Fortuna Ave Park Ridge IL 60068-1956 Ph: (847) 975-5128 | Crescent Moon Therapy, Llc 1123 Fortuna Ave Park Ridge IL 60068-1956 Ph: (847) 975-5128 |
| NPI Number | 1013663996 |
|---|---|
| Provider Enumeration Date | 03/01/2022 |
| Last Update Date | 02/06/2023 |
| Certification Date | 02/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013663996 | NPI | - | NPPES |
| 1205416328 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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