Provider Demographics
NPI:1417678145
Name:MANRRIQUEZ, CAROLINA (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:MANRRIQUEZ
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5345 S HERMITAGE AVE # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-5727
Mailing Address - Country:US
Mailing Address - Phone:312-678-6727
Mailing Address - Fax:
Practice Address - Street 1:11848 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4734
Practice Address - Country:US
Practice Address - Phone:773-431-0486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.108615104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker