Healthcare Provider Details

I. General information

NPI: 1720961402
Provider Name (Legal Business Name): KIERA CAROLYN MCCARROLL RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 HADDONFIELD RD
PENNSAUKEN NJ
08109-3376
US

IV. Provider business mailing address

4300 HADDONFIELD RD STE 110
PENNSAUKEN NJ
08109-3376
US

V. Phone/Fax

Practice location:
  • Phone: 856-406-0035
  • Fax:
Mailing address:
  • Phone: 856-406-0035
  • Fax: 856-406-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-396159
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: