Provider Demographics
NPI:1205634953
Name:BUENO, MARIMAR
Entity type:Individual
Prefix:
First Name:MARIMAR
Middle Name:
Last Name:BUENO
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 BLACKHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-1311
Mailing Address - Country:US
Mailing Address - Phone:224-551-1018
Mailing Address - Fax:
Practice Address - Street 1:1721 MOON LAKE BLVD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1069
Practice Address - Country:US
Practice Address - Phone:708-927-4127
Practice Address - Fax:708-927-4127
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-25-416823106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty