Provider Demographics
NPI:1972036945
Name:ROGERS, REBECCA SILVERMAN (MA, LCPC,)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SILVERMAN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MA, LCPC,
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SILVERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1740 RIDGE AVE STE 200B
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5903
Mailing Address - Country:US
Mailing Address - Phone:310-925-4148
Mailing Address - Fax:
Practice Address - Street 1:1740 RIDGE AVE STE 200B
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5903
Practice Address - Country:US
Practice Address - Phone:310-925-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2022-08-24
Deactivation Date:2019-08-10
Deactivation Code:
Reactivation Date:2022-05-24
Provider Licenses
StateLicense IDTaxonomies
IL180008181101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor