Provider Demographics
NPI:1841543527
Name:RODRIGUEZ, LUCERO EDITH (LPC)
Entity type:Individual
Prefix:MS
First Name:LUCERO
Middle Name:EDITH
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 S MOZART ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-2322
Mailing Address - Country:US
Mailing Address - Phone:773-671-1491
Mailing Address - Fax:
Practice Address - Street 1:3166 N LINCOLN AVE STE 224
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3119
Practice Address - Country:US
Practice Address - Phone:312-909-1007
Practice Address - Fax:773-327-4542
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.008769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional