=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003765330
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIANA MORENO-RODRIGUEZ LPC, MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2026
-----------------------------------------------------
Last Update Date | 01/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1701 E WOODFIELD RD
-----------------------------------------------------
City | SCHAUMBURG
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60173-5905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-306-9520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 704 PULASKI RD
-----------------------------------------------------
City | CALUMET CITY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60409-4017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 178.022545
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------