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NPI Code Detail

MEDICARE: HEARTHSTONE PSYCHOLOGY PLLC

MEDICARE: HEARTHSTONE PSYCHOLOGY PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1619770070
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEARTHSTONE PSYCHOLOGY PLLC
Provider Business Mailing Address
First Line : 4722 S GREENWOOD AVE APT 3W
Second Line :
City : CHICAGO
State : IL
Zip : 60615-1930
Country : US
Telephone Number : 865-806-3802
Fax Number :
Provider Business Practice Location Address
First Line : 2950 W CHICAGO AVE STE 202
Second Line :
City : CHICAGO
State : IL
Zip : 60622-4377
Country : US
Telephone Number : 865-806-3802
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. RACHEL SMITH
Credential : MA, PSYD
Telephone Number : 865-806-3802
Provider Enumeration Date : 03/31/2025
Last Update Date : 03/31/2025

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