Provider Demographics
NPI:1992216428
Name:RAY NGUYEN, REBEKAH ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ANN
Last Name:RAY NGUYEN
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 1:1400 W GREENLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2805
Mailing Address - Country:US
Mailing Address - Phone:312-785-3375
Mailing Address - Fax:773-262-4841
Practice Address - Street 1:1400 W GREENLEAF AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2805
Practice Address - Country:US
Practice Address - Phone:312-785-3375
Practice Address - Fax:773-262-4841
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0144691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical