Healthcare Provider Details

I. General information

NPI: 1205757788
Provider Name (Legal Business Name): WAVEPATH PSYCHOLOGICAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 MANCHESTER RD STE 301
WHEATON IL
60187-4584
US

IV. Provider business mailing address

2100 MANCHESTER RD STE 301
WHEATON IL
60187-4584
US

V. Phone/Fax

Practice location:
  • Phone: 787-447-0533
  • Fax:
Mailing address:
  • Phone: 787-447-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARLENE GRACE RIVERA RODRIGUEZ
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 787-447-0533