Provider Demographics
NPI:1184204398
Name:DANA PAVLIK LCSW, BCBA LLC
Entity Type:Organization
Organization Name:DANA PAVLIK LCSW, BCBA LLC
Other - Org Name:DANA PAVLIK LCSW, BCBA LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LCSW BCBA
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVLIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-852-5894
Mailing Address - Street 1:67 E MADISON ST STE 1603A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3062
Mailing Address - Country:US
Mailing Address - Phone:773-852-5894
Mailing Address - Fax:
Practice Address - Street 1:67 E MADISON ST STE 1603A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3062
Practice Address - Country:US
Practice Address - Phone:773-852-5894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty