Provider Demographics
NPI:1013244334
Name:ROSALES, MIRIAM (MA)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:ROSALES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:COVARRUBIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4851 N KEELER
Mailing Address - Street 2:APT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630
Mailing Address - Country:US
Mailing Address - Phone:773-733-6588
Mailing Address - Fax:
Practice Address - Street 1:5341 W CERMAK RD STE 201
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2892
Practice Address - Country:US
Practice Address - Phone:708-656-6430
Practice Address - Fax:708-656-6591
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL180-011364101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health