MEDICARE: CARLEY L PERLMAN MS, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BEH-000400	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-18-32831	OTHER		BOARD ANALYST CERTIFICATION BOARD
2	BEH-000400	OTHER	AZ	AZ STATE BOARD OF PSYCHOLOGIST EXAMINERS

General Provider Information

NPI Number	:	1003470584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLEY L PERLMAN MS, BCBA

Provider Business Mailing Address
First Line	:	2025 N 3RD ST STE 250
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1472
Country	:	US
Telephone Number	:	480-998-2920
Fax Number	:

Provider Business Practice Location Address
First Line	:	11024 N 28TH DR STE 110
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4378
Country	:	US
Telephone Number	:	602-944-6222
Fax Number	:	602-944-3534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2019
Last Update Date	:	04/30/2019

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