Provider Demographics
NPI:1689189508
Name:LAMOUREUX, MARYBETH (BCBA)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:LAMOUREUX
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W HAWTHORN DR
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-2056
Mailing Address - Country:US
Mailing Address - Phone:800-844-1232
Mailing Address - Fax:
Practice Address - Street 1:901 W HAWTHORN DR
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-2056
Practice Address - Country:US
Practice Address - Phone:800-844-1232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-26781103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst