Individual provider Active NPI

Roberto Renteria, PHD

  • Counseling Psychologist
  • Chicago, IL
National Provider Identifier
1841990819
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
Practice address
4711 N Broadway St Ste 105
Chicago, IL 60640-4908
Phone
(660) 349-0546
NPI assigned
Mar 7, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X Primary

Addresses

Primary practice location

4711 N Broadway St Ste 105
Chicago, IL 60640-4908

Mailing address

635 W Grace St Apt 703
Chicago, IL 60613-4022
Phone (660) 349-0546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

Interoperability endpoints

  • Direct secure messaging: roberto.renteria.1@3569.direct.athenahealth.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1841990819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 W GRACE ST APT 703",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606134022",
            "telephone_number": "660-349-0546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4711 N BROADWAY ST STE 105",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404908",
            "telephone_number": "660-349-0546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENTERIA",
        "first_name": "ROBERTO",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-07",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.