Healthcare Provider Details

I. General information

NPI: 1174014815
Provider Name (Legal Business Name): SMART BEHAVIOR SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S MARION ST STE 20
OAK PARK IL
60302-3159
US

IV. Provider business mailing address

212 S MARION ST STE 20
OAK PARK IL
60302-3159
US

V. Phone/Fax

Practice location:
  • Phone: 312-415-5507
  • Fax:
Mailing address:
  • Phone: 312-415-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER SERRANO
Title or Position: OWNER
Credential: LCSW
Phone: 312-415-5507