Provider Demographics
NPI:1427149996
Name:REY, TONI STAPLEY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TONI
Middle Name:STAPLEY
Last Name:REY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3076
Mailing Address - Country:US
Mailing Address - Phone:847-847-7644
Mailing Address - Fax:847-940-8510
Practice Address - Street 1:18 E. HARBOR DR.
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-3076
Practice Address - Country:US
Practice Address - Phone:847-847-7644
Practice Address - Fax:847-940-8510
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR16831Medicare UPIN
IL208099Medicare ID - Type UnspecifiedLCSW