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NPI Code Detail

MEDICARE: C2ACT, LLC

MEDICARE: C2ACT, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency149011093IL
2103K00000XBehavior Analyst
31041C0700XClinical Social Worker
4261QM0855XAdolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number : 1790054542
Entity Type Code : Organization
Provider Name (Legal Business Name) : C2ACT, LLC
Provider Business Mailing Address
First Line : 3417 N KENNICOTT AVE STE A
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60004-7824
Country : US
Telephone Number : 224-210-6694
Fax Number : 224-836-5174
Provider Business Practice Location Address
First Line : 3417 N KENNICOTT AVE STE A
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60004-7824
Country : US
Telephone Number : 224-210-6694
Fax Number : 224-836-5174
Authorized Official
Title or Position : LICENSED CLINICAL SOCIAL WORKER
Name : MARJORIE DIAZ RODRIGUEZ
Credential : MA
Telephone Number : 224-210-6694
Provider Enumeration Date : 12/23/2011
Last Update Date : 03/01/2022

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