Healthcare Provider Details

I. General information

NPI: 1154103547
Provider Name (Legal Business Name): JUAN MANUEL BARRIGA JR. PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CHATHAM RD # 8337
SPRINGFIELD IL
62704-4188
US

IV. Provider business mailing address

2506 N CLARK ST # 233
CHICAGO IL
60614-1848
US

V. Phone/Fax

Practice location:
  • Phone: 773-692-0543
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number071.011023
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.011023
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: