Provider Demographics
NPI:1992353510
Name:RODRIGUEZ, DEISY (LCPC)
Entity type:Individual
Prefix:
First Name:DEISY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:DEISY
Other - Middle Name:
Other - Last Name:PUENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1302
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60011-1302
Mailing Address - Country:US
Mailing Address - Phone:847-220-7286
Mailing Address - Fax:
Practice Address - Street 1:3245 GROVE AVE STE 208
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3476
Practice Address - Country:US
Practice Address - Phone:847-220-7286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty