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General NPI Number Information
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NPI Number | 1417518382
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Entity Type | Individual
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Provider Name | CARLY GLASSMEYER BCBA
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Gender | Female
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Dates
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Enumeration Date | 06/21/2019
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 95-732 MAIAKU ST
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City | MILILANI
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State | HI
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Zip | 96789-2816
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Country | US
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Telephone | 808-321-8105
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Fax |
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Provider Business Mailing Address
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Address Line | 411 HOBRON LN APT 1609
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City | HONOLULU
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State | HI
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Zip | 96815-1213
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Country | US
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Telephone | 513-382-0209
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA-856-0
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License Number State | HI
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