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General NPI Number Information
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NPI Number | 1407226855
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Entity Type | Organization
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Legal Business Name | REBECCA WYNNE DENOSAQUO-MURRAY
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Dates
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Enumeration Date | 09/28/2015
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Last Update Date | 09/28/2015
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Provider Practice Location Address
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Address Line | 545 LINCOLN AVE SUITE 15
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City | WINNETKA
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State | IL
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Zip | 60093-2349
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Country | US
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Telephone | 847-275-3389
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Fax |
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Provider Business Mailing Address
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Address Line | 902 N MOKI LN
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-1927
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Country | US
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Telephone | 847-275-3389
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. REBECCA DENOSAQUO
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Credential | PSY.D.
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Telephone | 847-275-3389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.007453
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License Number State | IL
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