Healthcare Provider Details

I. General information

NPI: 1033748223
Provider Name (Legal Business Name): CARINA RAELIEN CALIBUSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E CENTRAL AVE
SPOKANE WA
99208-1108
US

IV. Provider business mailing address

111 E CENTRAL AVE
SPOKANE WA
99208-1108
US

V. Phone/Fax

Practice location:
  • Phone: 509-867-3721
  • Fax: 866-240-0809
Mailing address:
  • Phone: 509-867-3721
  • Fax: 866-240-0809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: