Healthcare Provider Details

I. General information

NPI: 1174059034
Provider Name (Legal Business Name): RACHEL NITZARIM PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 GOLF MILL CTR SUITE 708
NILES IL
60714-1224
US

IV. Provider business mailing address

241 GOLF MILL CTR SUITE 708
NILES IL
60714-1224
US

V. Phone/Fax

Practice location:
  • Phone: 847-824-8366
  • Fax:
Mailing address:
  • Phone: 847-824-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071009544
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.009544
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: