Healthcare Provider Details

I. General information

NPI: 1942947684
Provider Name (Legal Business Name): ARI SAMUEL LAKRITZ PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2022
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT ANTHONYS WAY
ALTON IL
62002-4568
US

IV. Provider business mailing address

1 SAINT ANTHONYS WAY
ALTON IL
62002-4568
US

V. Phone/Fax

Practice location:
  • Phone: 186-474-6246
  • Fax:
Mailing address:
  • Phone: 186-474-6246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.010807
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: