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General NPI Number Information
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NPI Number | 1174237879
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Entity Type | Individual
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Provider Name | JONATHAN A BECERRIL BEHAVIOR TECHNICIAN
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Gender | Male
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 8 S MICHIGAN AVE STE 1700
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City | CHICAGO
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State | IL
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Zip | 60603-3353
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Country | US
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Telephone | 872-895-7942
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Fax | 800-391-8460
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Provider Business Mailing Address
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Address Line | 8 S MICHIGAN AVE STE 1700
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City | CHICAGO
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State | IL
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Zip | 60603-3353
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Country | US
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Telephone | 872-895-7942
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Fax | 800-391-8460
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-21-190389
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License Number State | IL
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