Healthcare Provider Details

I. General information

NPI: 1144183310
Provider Name (Legal Business Name): AMANI E'NAYA CARABALLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CLEMENTS BRIDGE RD STE 2
BARRINGTON NJ
08007-1812
US

IV. Provider business mailing address

1800 LAUREL RD
LINDENWOLD NJ
08021-5401
US

V. Phone/Fax

Practice location:
  • Phone: 856-617-0486
  • Fax:
Mailing address:
  • Phone: 856-617-0486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-492599
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: