Healthcare Provider Details

I. General information

NPI: 1730674961
Provider Name (Legal Business Name): ABBRE RAPHINEE- MAXINE MCCLAIN PSY.D, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 W CULLERTON ST UNIT 1
CHICAGO IL
60608-3318
US

IV. Provider business mailing address

1001 POTRERO AVE
SAN FRANCISCO CA
94110-3518
US

V. Phone/Fax

Practice location:
  • Phone: 309-634-6080
  • Fax:
Mailing address:
  • Phone: 415-206-5270
  • Fax: 415-206-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.014536
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: