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General NPI Number Information
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NPI Number | 1558087627
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Entity Type | Individual
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Provider Name | LILY ROSE ANDREA
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Gender | Female
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Dates
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Enumeration Date | 10/19/2022
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 959 W OGDEN AVE
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City | NAPERVILLE
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State | IL
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Zip | 60563-2911
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Country | US
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Telephone | 331-801-2988
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Fax |
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Provider Business Mailing Address
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Address Line | 4946 DOUGLAS RD APT 301
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3878
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Country | US
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Telephone | 630-841-7554
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.114153
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-236330
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License Number State | IL
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