Provider Demographics
NPI:1952891574
Name:IRAHETA, CAROLINA (RBT-18-47180, LPC)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:IRAHETA
Suffix:
Gender:F
Credentials:RBT-18-47180, LPC
Other - Prefix:MS
Other - First Name:CAROLINA
Other - Middle Name:A
Other - Last Name:IRAHETA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:850 W BARTLETT RD UNIT 14C
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4454
Mailing Address - Country:US
Mailing Address - Phone:630-864-7267
Mailing Address - Fax:630-596-0743
Practice Address - Street 1:850 W BARTLETT RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4454
Practice Address - Country:US
Practice Address - Phone:630-864-7267
Practice Address - Fax:630-596-0743
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-18-47180106S00000X
IL178.016474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician