| NPI | 1790054542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARJORIE DIAZ RODRIGUEZ Licensed Clinical Social Worker 224-210-6694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 1041C0700X Social Worker Clinical | |
| 251S00000X Community/Behavioral Health (Licence: IL 149011093) | |
| Enumeration Date | 2011-12-23 |
| Last Update Date | 2022-03-01 |