Provider Demographics
NPI:1124388574
Name:BARECKI, DAVID (PSYD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BARECKI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N VINCENT DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-5586
Mailing Address - Country:US
Mailing Address - Phone:773-459-2856
Mailing Address - Fax:
Practice Address - Street 1:6006 159TH ST BLDG C
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2904
Practice Address - Country:US
Practice Address - Phone:708-535-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-19
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010561103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical