For Real Therapy Inc

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

FOR REAL THERAPY INC

Practice address

1564 N Damen Ave Ste 208
Chicago, IL 60622-2102

Phone

(773) 888-1681

NPI assigned

Mar 24, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Fabrice Robert Lubin, PSYD

Title

Clinical Supervisor

Phone

(773) 888-1681

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585008000000",
    "number": "1114554722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1951 W SUNNYSIDE AVE APT 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405861",
            "telephone_number": "954-559-0073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1564 N DAMEN AVE STE 208",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222102",
            "telephone_number": "773-888-1681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOR REAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-24",
        "last_updated": "2020-03-24",
        "certification_date": "2020-03-24",
        "status": "A",
        "authorized_official_last_name": "LUBIN",
        "authorized_official_first_name": "FABRICE",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "CLINICAL SUPERVISOR",
        "authorized_official_telephone_number": "773-888-1681",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.