Organization
ROCKLAND PROFESSIONAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRETT A SISLER LCSW (OWNER ADMINISTRATOR)
(847) 816-9180
Entity
Organization
Contact information
Practice address
114 W ROCKLAND RD, LIBERTYVILLE, IL 60048-2774
(847) 816-9180
(847) 816-9183
Mailing address
114 W ROCKLAND RD, LIBERTYVILLE, IL 60048-2774
(847) 816-9180
(847) 816-9183
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04920480
BLUE CROSS BLUE SHIELD
IL
Enumeration date
12/15/2006
Last updated
11/27/2007
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