Provider Demographics
NPI:1578879433
Name:DIAZ RODRIGUEZ, MARJORIE (LCSW, BCBA)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:DIAZ RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 E PALATINE RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-5777
Mailing Address - Country:US
Mailing Address - Phone:847-772-2029
Mailing Address - Fax:
Practice Address - Street 1:3417 N KENNICOTT AVE STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7824
Practice Address - Country:US
Practice Address - Phone:224-210-6694
Practice Address - Fax:224-836-5174
Is Sole Proprietor?:No
Enumeration Date:2010-08-28
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0110931041C0700X
IL1-19-37412103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical