Provider Demographics
NPI:1912497918
Name:BRIGHT, CALEB M (RBT-17-30078)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:M
Last Name:BRIGHT
Suffix:
Gender:M
Credentials:RBT-17-30078
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4222
Mailing Address - Country:US
Mailing Address - Phone:815-997-0921
Mailing Address - Fax:
Practice Address - Street 1:5 REVERE DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1566
Practice Address - Country:US
Practice Address - Phone:844-247-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17-30078106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician