Provider Demographics
NPI:1386724243
Name:MIZRACHI, JUDITH (LCPC)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:MIZRACHI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 W GREENLEAF AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2916
Mailing Address - Country:US
Mailing Address - Phone:773-575-4307
Mailing Address - Fax:773-764-2038
Practice Address - Street 1:5419 N SHERIDAN RD
Practice Address - Street 2:SUITE 103 A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1964
Practice Address - Country:US
Practice Address - Phone:773-575-4307
Practice Address - Fax:773-764-2038
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634661OtherBCBS
ILU0348-0591OtherCIGNA