Provider Demographics
NPI:1306238209
Name:DAVIS, REBECCA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 W CATON ST
Mailing Address - Street 2:#2E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6256
Mailing Address - Country:US
Mailing Address - Phone:708-574-3416
Mailing Address - Fax:
Practice Address - Street 1:2113 W CATON ST
Practice Address - Street 2:#2E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6256
Practice Address - Country:US
Practice Address - Phone:708-574-3416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490150481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical