Healthcare Provider Details

I. General information

NPI: 1164385050
Provider Name (Legal Business Name): ELIO THEODORE CARBERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 S POTOMAC ST STE 11
AURORA CO
80012-4527
US

IV. Provider business mailing address

1330 S POTOMAC ST
AURORA CO
80012-4527
US

V. Phone/Fax

Practice location:
  • Phone: 720-845-6675
  • Fax:
Mailing address:
  • Phone: 720-845-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: