Provider Demographics
NPI:1225691272
Name:LODESTAR BEHAVIOR THERAPY
Entity Type:Organization
Organization Name:LODESTAR BEHAVIOR THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SILVA
Authorized Official - Middle Name:VARTOOMIAN
Authorized Official - Last Name:KLEINFELD
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:847-440-6366
Mailing Address - Street 1:2717 N LEHMANN CT APT 1A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1664
Mailing Address - Country:US
Mailing Address - Phone:847-440-6366
Mailing Address - Fax:
Practice Address - Street 1:2717 N LEHMANN CT APT 1A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1664
Practice Address - Country:US
Practice Address - Phone:847-440-6366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty