Healthcare Provider Details

I. General information

NPI: 1326300393
Provider Name (Legal Business Name): CAROLINE JANE HUARTE PH.D., BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE JANE WHITE PH.D., BCBA-D

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 CAMINO DEL RIO S SUITE 301
SAN DIEGO CA
92108-3903
US

IV. Provider business mailing address

3443 CAMINO DEL RIO S SUITE 301
SAN DIEGO CA
92108-3903
US

V. Phone/Fax

Practice location:
  • Phone: 619-201-2010
  • Fax: 619-243-7387
Mailing address:
  • Phone: 619-201-2010
  • Fax: 619-243-7387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY25564
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-15842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: