Provider Demographics
NPI:1851083570
Name:AUTISM BEHAVIOR THERAPY
Entity type:Organization
Organization Name:AUTISM BEHAVIOR THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTONELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CIUPE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:773-306-6239
Mailing Address - Street 1:124 KRAML DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0303
Mailing Address - Country:US
Mailing Address - Phone:630-631-9623
Mailing Address - Fax:630-290-0522
Practice Address - Street 1:44 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4402
Practice Address - Country:US
Practice Address - Phone:855-528-8476
Practice Address - Fax:630-687-8737
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUTISM BEHAVIOR THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-22
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty