Provider Demographics
NPI:1336764364
Name:GARCIA-KANTOLA, LILIANA (RBT-20-121371)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:GARCIA-KANTOLA
Suffix:
Gender:F
Credentials:RBT-20-121371
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-8604
Mailing Address - Country:US
Mailing Address - Phone:630-802-0594
Mailing Address - Fax:
Practice Address - Street 1:873 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-8604
Practice Address - Country:US
Practice Address - Phone:630-802-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-20-121371106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician