Provider Demographics
NPI:1124154661
Name:RAE RICH, LCSW, PC
Entity type:Organization
Organization Name:RAE RICH, LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-687-3085
Mailing Address - Street 1:1509 W BERWYN AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-8056
Mailing Address - Country:US
Mailing Address - Phone:847-687-3085
Mailing Address - Fax:
Practice Address - Street 1:1509 W BERWYN AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-8056
Practice Address - Country:US
Practice Address - Phone:847-687-3085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149002472251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623160OtherBLUE CROSS BLUE SHIELD
IL1982641627OtherPERSONAL NPI
IL1982641627OtherPERSONAL NPI