Provider Demographics
NPI:1497007520
Name:MACH, REBECCA (PSYD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MACH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5844 N HERMITAGE AVE
Mailing Address - Street 2:APT B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3192
Mailing Address - Country:US
Mailing Address - Phone:773-495-6614
Mailing Address - Fax:
Practice Address - Street 1:5844 N HERMITAGE AVE APT B
Practice Address - Street 2:102A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-8901
Practice Address - Country:US
Practice Address - Phone:773-495-6614
Practice Address - Fax:206-202-2205
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-13
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008288101YP2500X
IL071.009505103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional