1497272769 NPI number — LAKEFRONT COUNSELING GROUP, LTD.

Table of content: DR. ANGEL LUIS RIVERA JR. M.D. (NPI 1578610028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497272769 NPI number — LAKEFRONT COUNSELING GROUP, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKEFRONT COUNSELING GROUP, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497272769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 N MICHIGAN AVE STE 609
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60601-7511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-942-2006
Provider Business Mailing Address Fax Number:
312-239-6000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 N MICHIGAN AVE STE 609
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60601-7506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-942-2006
Provider Business Practice Location Address Fax Number:
312-239-6000
Provider Enumeration Date:
08/27/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
ROBYNE
Authorized Official Middle Name:
FRANKFORT
Authorized Official Title or Position:
PSYCHOLOGIST, OWNER
Authorized Official Telephone Number:
847-942-2006

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  071006138 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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