Provider Demographics
NPI:1982641627
Name:RICH, RAE E (LCSW)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:E
Last Name:RICH
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 1:1509 W BERWYN AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-8056
Mailing Address - Country:US
Mailing Address - Phone:847-687-3085
Mailing Address - Fax:
Practice Address - Street 1:1509 W BERWYN AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-8056
Practice Address - Country:US
Practice Address - Phone:847-687-3085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490024721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623160OtherBLUE CROSS BLUE SHIELD
IL502000Medicare ID - Type Unspecified