Provider Demographics
NPI:1740812346
Name:MACHABANSKI, ROSA (MSW)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:MACHABANSKI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 MARVELL LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3641
Mailing Address - Country:US
Mailing Address - Phone:847-293-8585
Mailing Address - Fax:
Practice Address - Street 1:JOSSELYN CENTER
Practice Address - Street 2:405 CENTRAL AVE
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093
Practice Address - Country:US
Practice Address - Phone:847-441-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health