Provider Demographics
NPI:1841990819
Name:RENTERIA, ROBERTO (PHD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:RENTERIA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 W GRACE ST APT 703
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4022
Mailing Address - Country:US
Mailing Address - Phone:660-349-0546
Mailing Address - Fax:
Practice Address - Street 1:4711 N BROADWAY ST STE 105
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4908
Practice Address - Country:US
Practice Address - Phone:660-349-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling