Provider Demographics
NPI:1609897974
Name:ASSOCIATED BEHAVIORAL THERAPEUTICS INC
Entity Type:Organization
Organization Name:ASSOCIATED BEHAVIORAL THERAPEUTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:T
Authorized Official - Last Name:WALTZER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-777-7413
Mailing Address - Street 1:4835 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2719
Mailing Address - Country:US
Mailing Address - Phone:773-777-7413
Mailing Address - Fax:773-777-7416
Practice Address - Street 1:4835 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2719
Practice Address - Country:US
Practice Address - Phone:773-777-7413
Practice Address - Fax:773-777-7416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL984470Medicare ID - Type UnspecifiedMEDICARE NUMBER