Provider Demographics
NPI:1417041583
Name:PISZCZOR, RACHEL A (PSYD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:A
Last Name:PISZCZOR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 N WELLS ST
Mailing Address - Street 2:TCSPP-MERCHANDISE MART OFFICE 1355
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-7024
Mailing Address - Country:US
Mailing Address - Phone:703-599-1168
Mailing Address - Fax:
Practice Address - Street 1:222 MERCHANDISE MART PLZ
Practice Address - Street 2:TCSPP-13TH FLOOR-OFFICE 1355
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-1103
Practice Address - Country:US
Practice Address - Phone:703-599-1168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007429103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent