Provider Demographics
NPI:1134478522
Name:SMITH, RACHEL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:DUBROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5225 OLD ORCHARD ROAD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077
Mailing Address - Country:US
Mailing Address - Phone:847-313-8074
Mailing Address - Fax:847-278-2220
Practice Address - Street 1:5225 OLD ORCHARD ROAD
Practice Address - Street 2:SUITE 5
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:847-313-8074
Practice Address - Fax:847-278-2220
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
IL1490151381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL7658Medicare PIN