Healthcare Provider Details

I. General information

NPI: 1790197788
Provider Name (Legal Business Name): MARJORY RUTH REIMER PSYD, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N MCCLURG CT APT 3803A
CHICAGO IL
60611-3030
US

IV. Provider business mailing address

600 N MCCLURG CT APT 3803A
CHICAGO IL
60611-3030
US

V. Phone/Fax

Practice location:
  • Phone: 773-477-2744
  • Fax:
Mailing address:
  • Phone: 312-678-8496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23364
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: