Healthcare Provider Details

I. General information

NPI: 1396545646
Provider Name (Legal Business Name): JULIA LILLIE RAE LOFARO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 TOWNSHIP LINE RD
PLAINFIELD IN
46168-7517
US

IV. Provider business mailing address

709 KIRKWOOD DR
GREENCASTLE IN
46135-1107
US

V. Phone/Fax

Practice location:
  • Phone: 317-914-3176
  • Fax: 844-742-6592
Mailing address:
  • Phone: 765-655-4143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-418894
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: