Healthcare Provider Details

I. General information

NPI: 1417518382
Provider Name (Legal Business Name): CARLY GLASSMEYER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-732 MAIAKU ST
MILILANI HI
96789-2816
US

IV. Provider business mailing address

411 HOBRON LN APT 1609
HONOLULU HI
96815-1213
US

V. Phone/Fax

Practice location:
  • Phone: 808-321-8105
  • Fax:
Mailing address:
  • Phone: 513-382-0209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-856-0
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: