Provider Demographics
NPI:1467618272
Name:OMAN, MARIENE (LCPC)
Entity Type:Individual
Prefix:DR
First Name:MARIENE
Middle Name:
Last Name:OMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 SPRING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-6325
Mailing Address - Country:US
Mailing Address - Phone:815-639-9405
Mailing Address - Fax:815-639-9407
Practice Address - Street 1:5055 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-6325
Practice Address - Country:US
Practice Address - Phone:815-639-9405
Practice Address - Fax:815-639-9407
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001148101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10121002OtherBLUE CROSS BLUE SHIELD