Provider Demographics
NPI:1649711573
Name:AUTISM BEHAVIOR THERAPY
Entity type:Organization
Organization Name:AUTISM BEHAVIOR THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHADEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:630-631-9623
Mailing Address - Street 1:124 KRAML DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0303
Mailing Address - Country:US
Mailing Address - Phone:630-631-9623
Mailing Address - Fax:630-920-0522
Practice Address - Street 1:124 KRAML DR
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-0303
Practice Address - Country:US
Practice Address - Phone:630-631-9623
Practice Address - Fax:630-920-0522
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUTISM BEHAVIOR THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-11
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL11520882251E00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty