Provider Demographics
NPI:1598584120
Name:DAMATO, RACHEL MARIE (LSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:DAMATO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:MARIE
Other - Last Name:TASSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5835 N WINTHROP AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3883
Mailing Address - Country:US
Mailing Address - Phone:630-809-6943
Mailing Address - Fax:
Practice Address - Street 1:622 DAVIS ST STE 200
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4491
Practice Address - Country:US
Practice Address - Phone:773-294-0176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.114603104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker