Provider Demographics
NPI:1568077592
Name:BANIBAKER, AFNAN (RBT, BCAT)
Entity Type:Individual
Prefix:
First Name:AFNAN
Middle Name:
Last Name:BANIBAKER
Suffix:
Gender:F
Credentials:RBT, BCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 S CICERO AVE STE F
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4098
Mailing Address - Country:US
Mailing Address - Phone:708-232-8763
Mailing Address - Fax:
Practice Address - Street 1:6419 W 87TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-1048
Practice Address - Country:US
Practice Address - Phone:708-634-0821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician