Provider Demographics
NPI:1619507787
Name:RODRIGUEZ, ANTHONY M (QMHP, LCPC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:QMHP, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 N ARTESIAN AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5308
Mailing Address - Country:US
Mailing Address - Phone:219-781-3561
Mailing Address - Fax:
Practice Address - Street 1:1625 N ARTESIAN AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5308
Practice Address - Country:US
Practice Address - Phone:219-781-3561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional