Provider Demographics
NPI:1790197788
Name:REIMER, MARJORY RUTH (PSYD, CADC)
Entity Type:Individual
Prefix:
First Name:MARJORY
Middle Name:RUTH
Last Name:REIMER
Suffix:
Gender:F
Credentials:PSYD, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N MCCLURG CT APT 3803A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3030
Mailing Address - Country:US
Mailing Address - Phone:312-678-8496
Mailing Address - Fax:
Practice Address - Street 1:600 N MCCLURG CT APT 3803A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3030
Practice Address - Country:US
Practice Address - Phone:773-477-2744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL23364101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health