Provider Demographics
NPI:1376084178
Name:LICHTENBERG, CASSANDRA (BCABA)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:LICHTENBERG
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:BARNHART
Mailing Address - State:MO
Mailing Address - Zip Code:63012-1483
Mailing Address - Country:US
Mailing Address - Phone:314-255-7253
Mailing Address - Fax:314-845-3900
Practice Address - Street 1:7049 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4319
Practice Address - Country:US
Practice Address - Phone:314-706-1842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017006314106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst