Healthcare Provider Details

I. General information

NPI: 1649874538
Provider Name (Legal Business Name): CAROLYN R MACMURTRIE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 OLD EAGLE SCHOOL RD
WAYNE PA
19087-1707
US

IV. Provider business mailing address

542 AMHERST ST STE B
NASHUA NH
03063-1016
US

V. Phone/Fax

Practice location:
  • Phone: 844-528-1222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-45760
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: