Provider Demographics
NPI:1144386913
Name:HERNANDEZ, RACHEL R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:R
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-8050
Mailing Address - Country:US
Mailing Address - Phone:815-933-2679
Mailing Address - Fax:815-933-2116
Practice Address - Street 1:4440 LINCOLN HWY
Practice Address - Street 2:STE. 307
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2349
Practice Address - Country:US
Practice Address - Phone:815-509-9974
Practice Address - Fax:815-933-2116
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633668OtherBCBS PROVIDER ID NUMBER
IL555636OtherVALUE OPTIONS PROVIDER ID