Provider Demographics
NPI:1073738423
Name:RACENSTEIN, MEG (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEG
Middle Name:
Last Name:RACENSTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:MEG
Other - Last Name:RACENSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3200 WILMETTE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2957
Mailing Address - Country:US
Mailing Address - Phone:847-251-7929
Mailing Address - Fax:847-251-7926
Practice Address - Street 1:630 N. VERNON AVE.
Practice Address - Street 2:SUITE G
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022
Practice Address - Country:US
Practice Address - Phone:847-835-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist