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RODRIGO MANJARRES MA

Addiction Substance Use Disorder

Waukegan, Illinois

Provider NPI: 1376563916

Provider Information:
 RODRIGO  MANJARRES MA
Gender: M
Not Sole Proprietor

Practice Location:
3012 GRAND AVE  WAUKEGAN, IL 60085 US
Tel: 847-546-0080  Fax: 847-546-0083

Business Mailing Address:
135 N GREENLEAF ST SUITE 201 GURNEE, IL 60031 US
Tel: 847-360-8860  Fax: 847-360-8864

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
IL5176
Y101YM0800XBehavioral Health & Social Service Providers
Counselor
IL

Other Provider Identifiers:

IssuerNumberStateType
BLUECROSS BLUESHIELD8008517498IL01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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