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General NPI Number Information
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NPI Number | 1841543527
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Entity Type | Individual
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Provider Name | LUCERO EDITH RODRIGUEZ LPC
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Gender | Female
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 3166 N LINCOLN AVE STE 224
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City | CHICAGO
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State | IL
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Zip | 60657-3119
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Country | US
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Telephone | 312-909-1007
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Fax | 773-327-4542
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Provider Business Mailing Address
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Address Line | 6225 S MOZART ST
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City | CHICAGO
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State | IL
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Zip | 60629-2322
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Country | US
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Telephone | 773-671-1491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.008769
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License Number State | IL
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