Provider Demographics
NPI:1093205551
Name:BELLEL, KAFI (RBT-18-48391)
Entity Type:Individual
Prefix:
First Name:KAFI
Middle Name:
Last Name:BELLEL
Suffix:
Gender:M
Credentials:RBT-18-48391
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 N KILDARE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-1708
Mailing Address - Country:US
Mailing Address - Phone:312-971-7848
Mailing Address - Fax:
Practice Address - Street 1:1443 N KILDARE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-1708
Practice Address - Country:US
Practice Address - Phone:312-971-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-18-48391106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician