Provider Demographics
NPI:1366195299
Name:REBOLLAR, GABRIELA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GABRIELA
Middle Name:
Last Name:REBOLLAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18700 WOLF RD STE 225
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8762
Mailing Address - Country:US
Mailing Address - Phone:815-249-1294
Mailing Address - Fax:815-205-4406
Practice Address - Street 1:18700 WOLF RD STE 225
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8762
Practice Address - Country:US
Practice Address - Phone:815-249-1294
Practice Address - Fax:815-205-4406
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.106253104100000X
IL1490293421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker