Provider Demographics
NPI:1215317508
Name:DR. DAVID RAKOFSKY PC
Entity type:Organization
Organization Name:DR. DAVID RAKOFSKY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAKOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-384-1940
Mailing Address - Street 1:1011 W WELLINGTON AVE
Mailing Address - Street 2:#210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7187
Mailing Address - Country:US
Mailing Address - Phone:312-384-1940
Mailing Address - Fax:773-423-8444
Practice Address - Street 1:3139 N LINCOLN AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3114
Practice Address - Country:US
Practice Address - Phone:312-384-1940
Practice Address - Fax:773-423-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0154721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty