Healthcare Provider Details

I. General information

NPI: 1629295308
Provider Name (Legal Business Name): MARC NATHAN PECHTER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 CENTRAL AVE
NORTHFIELD IL
60093-3006
US

IV. Provider business mailing address

3900 N LAKE SHORE DR UNIT 19J
CHICAGO IL
60613-3452
US

V. Phone/Fax

Practice location:
  • Phone: 847-441-5600
  • Fax:
Mailing address:
  • Phone: 773-562-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: