Provider Demographics
NPI:1780446047
Name:MCCORMIC, REBECCA (MA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MCCORMIC
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 1:6354 N PAULINA ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1648
Mailing Address - Country:US
Mailing Address - Phone:605-644-6497
Mailing Address - Fax:
Practice Address - Street 1:8707 SKOKIE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2281
Practice Address - Country:US
Practice Address - Phone:605-644-6497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health