MEDICARE: IPSITA CHAKRABARTI 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	1-16-23582	TX

General Provider Information

NPI Number	:	1750832523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IPSITA CHAKRABARTI BCBA

Provider Business Mailing Address
First Line	:	2901 BARTON SKWY
Second Line	:	APT 3407
City	:	AUSTIN
State	:	TX
Zip	:	78746-6911
Country	:	US
Telephone Number	:	737-932-5522
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 BARTON SKWY
Second Line	:	APT 3407
City	:	AUSTIN
State	:	TX
Zip	:	78746-6911
Country	:	US
Telephone Number	:	737-932-5522
Fax Number	:

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

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	10/17/2016

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