Provider Demographics
NPI:1457987851
Name:RENTERIA, RACHAEL (MA)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E GRAND AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3800
Mailing Address - Country:US
Mailing Address - Phone:630-935-7061
Mailing Address - Fax:847-686-0090
Practice Address - Street 1:160 E GRAND AVE STE 500
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3800
Practice Address - Country:US
Practice Address - Phone:630-935-7061
Practice Address - Fax:847-686-0090
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health