Provider Demographics
NPI:1649780016
Name:MADRIGAL CONSULTING AND COUNSELING LLP
Entity Type:Organization
Organization Name:MADRIGAL CONSULTING AND COUNSELING LLP
Other - Org Name:MADRIGAL TRANSITION COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:GEN PTR
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MADRIGAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:331-262-4049
Mailing Address - Street 1:450 E 22ND ST STE 150
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6118
Mailing Address - Country:US
Mailing Address - Phone:331-262-4049
Mailing Address - Fax:
Practice Address - Street 1:450 E 22ND ST STE 150
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6118
Practice Address - Country:US
Practice Address - Phone:331-262-4049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0048981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty