Provider Demographics
NPI:1609322791
Name:DIANE BUBECK LTD
Entity Type:Organization
Organization Name:DIANE BUBECK LTD
Other - Org Name:DIANE BUBECK & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:BUBECK
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LMFT
Authorized Official - Phone:630-369-5645
Mailing Address - Street 1:3528 BECKET LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4141
Mailing Address - Country:US
Mailing Address - Phone:630-369-5645
Mailing Address - Fax:630-369-5651
Practice Address - Street 1:3528 BECKET LN
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4141
Practice Address - Country:US
Practice Address - Phone:630-664-9702
Practice Address - Fax:630-369-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000604106H00000X
IL164.001456133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty