Healthcare Provider Details

I. General information

NPI: 1700795200
Provider Name (Legal Business Name): CLARE MACZKA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 WATERMAN AVE STE D
EAST PROVIDENCE RI
02914-1700
US

IV. Provider business mailing address

130 4TH ST APT 2
PROVIDENCE RI
02906-2804
US

V. Phone/Fax

Practice location:
  • Phone: 401-219-1351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA00563
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: