Provider Demographics
NPI:1407226855
Name:REBECCA WYNNE DENOSAQUO-MURRAY
Entity Type:Organization
Organization Name:REBECCA WYNNE DENOSAQUO-MURRAY
Other - Org Name:REBECCA DENOSAQUO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENOSAQUO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-275-3389
Mailing Address - Street 1:902 N MOKI LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1927
Mailing Address - Country:US
Mailing Address - Phone:847-275-3389
Mailing Address - Fax:
Practice Address - Street 1:545 LINCOLN AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2349
Practice Address - Country:US
Practice Address - Phone:847-275-3389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007453103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty