Provider Demographics
NPI:1457074791
Name:RODRIGUEZ RIVERA, REBECCA LEANDRA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LEANDRA
Last Name:RODRIGUEZ RIVERA
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 1:4116 1/2 N SHERIDAN RD APT 1E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2040
Mailing Address - Country:US
Mailing Address - Phone:787-605-3511
Mailing Address - Fax:
Practice Address - Street 1:4732 N AUSTIN AVE UNIT A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3785
Practice Address - Country:US
Practice Address - Phone:847-340-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program