=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851083570
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUTISM BEHAVIOR THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2023
-----------------------------------------------------
Last Update Date | 07/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 W ROOSEVELT RD
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148-4402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-528-8476
-----------------------------------------------------
Fax | 630-687-8737
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 124 KRAML DR
-----------------------------------------------------
City | BURR RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60527-0303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-631-9623
-----------------------------------------------------
Fax | 630-290-0522
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | SHADEN KASSAR
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 630-631-9623
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------