| First Domino Pediatric Behavior Therapy | |
|
4403 W Lawrence Ave Ste 200d Chicago IL 60630-2513 | |
| (773) 614-4649 | |
| Not Available |
| Full Name | First Domino Pediatric Behavior Therapy |
|---|---|
| Speciality | Behavior Analyst |
| Location | 4403 W Lawrence Ave Ste 200d, Chicago, Illinois |
| Authorized Official Name and Position | Rocco Catrone (CLINICAL DIRECTOR) |
| Authorized Official Contact | 7082681766 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| First Domino Pediatric Behavior Therapy 2737 W Chanay St Apt 3 Chicago IL 60647-4071 Ph: (708) 268-1766 | First Domino Pediatric Behavior Therapy 4403 W Lawrence Ave Ste 200d Chicago IL 60630-2513 Ph: (773) 614-4649 |
| NPI Number | 1467933770 |
|---|---|
| Provider Enumeration Date | 08/24/2018 |
| Last Update Date | 08/24/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467933770 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-16-22588 (Illinois) | Primary |
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