Provider Demographics
NPI:1457639437
Name:MANRIQUE, ROBERT EDWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDWARD
Last Name:MANRIQUE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 N SHERIDAN RD
Mailing Address - Street 2:1514
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1954
Mailing Address - Country:US
Mailing Address - Phone:312-218-5293
Mailing Address - Fax:
Practice Address - Street 1:5419 N SHERIDAN RD
Practice Address - Street 2:SUITE 103A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1964
Practice Address - Country:US
Practice Address - Phone:312-944-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0128551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical