Provider Demographics
NPI:1457853558
Name:DEMETRIUS-LALLAS, BARBARA DIANNE
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:DIANNE
Last Name:DEMETRIUS-LALLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1859 PENFOLD PL
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6034
Mailing Address - Country:US
Mailing Address - Phone:847-293-3259
Mailing Address - Fax:
Practice Address - Street 1:1859 PENFOLD PL
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6034
Practice Address - Country:US
Practice Address - Phone:847-293-3259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178011143101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty