Provider Demographics
NPI:1790054542
Name:C2ACT, LLC
Entity Type:Organization
Organization Name:C2ACT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:224-210-6694
Mailing Address - Street 1:3417 N KENNICOTT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7824
Mailing Address - Country:US
Mailing Address - Phone:224-210-6694
Mailing Address - Fax:224-836-5174
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 1041C0700X, 261QM0855X
IL149011093251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty