MEDICARE: CAROLINE GRACE FIRESTONE

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1265304315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE GRACE FIRESTONE

Provider Business Mailing Address
First Line	:	996 ROYAL MARCO WAY
Second Line	:
City	:	MARCO ISLAND
State	:	FL
Zip	:	34145-1829
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7220 TRADE ST STE 385
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-0002
Country	:	US
Telephone Number	:	858-278-6603
Fax Number	:

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

Provider Enumeration Date	:	09/18/2025
Last Update Date	:	09/18/2025

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Directions to “ CAROLINE GRACE FIRESTONE ” Practice Location

Language	Start Address	Practice Location

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