Logan Square Counseling LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071008195 Issued in IL

Legal business name

LOGAN SQUARE COUNSELING LLC

Practice address

2724 N Kedzie Ave
Chicago, IL 60647-1514

Phone

(773) 245-3725

Fax

(773) 453-7258

NPI assigned

Jul 15, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Mark Thomas Sciarrino, PSYD

Title

President, Licensed Psychologist

Phone

(773) 245-3725

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1468540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471219200000",
    "number": "1386097186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2724 N KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606471514",
            "telephone_number": "773-245-3725",
            "fax_number": "773-453-7258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2724 N KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606471514",
            "telephone_number": "773-245-3725",
            "fax_number": "773-453-7258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN SQUARE COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-15",
        "last_updated": "2016-08-15",
        "status": "A",
        "authorized_official_last_name": "SCIARRINO",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT, LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "773-245-3725",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORGANIZATION PRESIDENT AND SOLE PROVIDER'S RENDERING NPI",
            "identifier": "1861763914",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy Michael Loftus, M.D.
• Logan Authorization
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• Logan Square Acupuncture, LLC
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• Logan Square Dental Service Center
• Logan Square Foot Center
• Logan Square Foot Center PC
• Logan Square Medical Institute SC
• Logan Square MRI

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2016; 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.