Provider Demographics
NPI:1932530870
Name:LABERGE, ELIZABETH NICOLE (BCBA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:LABERGE
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 1:19060 EVERETT BLVD UNIT 107
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2500
Mailing Address - Country:US
Mailing Address - Phone:815-641-9187
Mailing Address - Fax:779-324-5236
Practice Address - Street 1:19060 EVERETT BLVD UNIT 107
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-2500
Practice Address - Country:US
Practice Address - Phone:815-641-9187
Practice Address - Fax:779-324-5236
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-13-15005103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst