Healthcare Provider Details

I. General information

NPI: 1700388980
Provider Name (Legal Business Name): CARLY ANSON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARLY ANSON MS, BCBA

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON AVE FL 5
TOWSON MD
21204-4763
US

IV. Provider business mailing address

505 WINDY KNOLL DR UNIT 323
MOUNT AIRY MD
21771-6614
US

V. Phone/Fax

Practice location:
  • Phone: 240-668-4415
  • Fax: 240-673-6322
Mailing address:
  • Phone: 240-668-4415
  • Fax: 240-673-6322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA731
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: