MEDICARE: MAURICIO RODRIGUEZ NAIME

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
1	101YM0800X	Mental Health Counselor		IL
2	101YP2500X	Professional Counselor	180.015894	IL

General Provider Information

NPI Number	:	1710769021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURICIO RODRIGUEZ NAIME

Provider Business Mailing Address
First Line	:	4250 N MARINE DR APT 2529
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1741
Country	:	US
Telephone Number	:	312-415-2375
Fax Number	:

Provider Business Practice Location Address
First Line	:	4250 N MARINE DR APT 2529
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1741
Country	:	US
Telephone Number	:	312-415-2375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2023
Last Update Date	:	04/25/2025

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