=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194238014
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLTON ALEXANDER POWELL RBT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2017
-----------------------------------------------------
Last Update Date | 11/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 197 DIVISION ST APT 10
-----------------------------------------------------
City | DENNIS PORT
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02639-1230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-208-1034
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 197 DIVISION ST APT 10
-----------------------------------------------------
City | DENNIS PORT
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02639-1230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-208-1034
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------