Healthcare Provider Details

I. General information

NPI: 1376084178
Provider Name (Legal Business Name): CASSANDRA LICHTENBERG BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7049 PERSHING AVE
SAINT LOUIS MO
63130-4319
US

IV. Provider business mailing address

1795 PRIMROSE LN
BARNHART MO
63012-1483
US

V. Phone/Fax

Practice location:
  • Phone: 314-706-1842
  • Fax:
Mailing address:
  • Phone: 314-255-7253
  • Fax: 314-845-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number2017006314
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: