Pamela Rezek, PH.D.

Key facts

NPI

1902277007

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Psychologist 103TC0700X

License

071005210 (IL)

Practice address

630 Vernon Ave Ste G
Glencoe, IL 60022-1689

Phone

(847) 630-1052

NPI assigned

Oct 14, 2015

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Doctor of Philosophy

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 23, 2019.

{
    "created_epoch": "1444780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563840000000",
    "number": "1902277007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 VERNON AVE STE G",
            "city": "GLENCOE",
            "state": "IL",
            "postal_code": "600221689",
            "telephone_number": "847-630-1052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 VERNON AVE STE G",
            "city": "GLENCOE",
            "state": "IL",
            "postal_code": "600221689",
            "telephone_number": "847-630-1052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZEK",
        "first_name": "PAMELA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-14",
        "last_updated": "2019-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071005210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michelle Ann Peifley, DDS
• Meg Racenstein, PH.D.
• Amera Manzoor Rahman, M.D.
• Ana Carolina Richter Da Fonseca Balthazar
• Matthew Rosenberg
• Ronald Rosenberg, M.D.
• Alec Ross, MSW,LCSW,RDDP
• Susan Rotman

All providers in Glencoe, IL · Clinical Psychologist in Illinois