Innerbloom Therapy Practice PC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

INNERBLOOM THERAPY PRACTICE PC

Practice address

2656 W Montrose Avenue
Suite 104
Chicago, IL 60618

Phone

(773) 969-6030

NPI assigned

Jun 7, 2022

Organization subpart

No

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

Authorized official

Name

Ms. Denise Lynn Gulotta, LCSWNPI 1053836585

Title

President

Phone

(773) 969-6030

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Denise Gulotta, LCSW

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1053836585
  NPD Authorized official

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

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691452800000",
    "number": "1457080301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 N CLYBOURN AVE",
            "address_2": "SUITE A BOX 222",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60610",
            "telephone_number": "773-969-6030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2656 W MONTROSE AVENUE",
            "address_2": "SUITE 104",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60618",
            "telephone_number": "773-969-6030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNERBLOOM THERAPY PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-07",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A",
        "authorized_official_last_name": "GULOTTA",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-969-6030",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "denise@innerbloomtherapypractice.com",
            "affiliation": "N",
            "endpointDescription": "businness email",
            "address_1": "2656 W Montrose Avenue",
            "address_2": "Suite 104",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Inner-City Muslim Action Network
• Inner-City Muslim Action Network
• Inner-City Muslim Action Network
• Inner-City Muslim Action Network
• Inner-City Muslim Action Network
• Innergy Behavioral Health Services, LLC
• Innergy Behavioral Health Services, LLC
• Innershine Associates, LLC
• Innervital Wabash PLLC
• Innerwell Therapeutic & Wellness Services, LLC

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; 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.