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NPI Code Detail

MEDICARE: KACI CARROLL

MEDICARE: KACI CARROLL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-16-25979NJ
2103K00000XBehavior Analyst1-19-40382NJ

General Provider Information

NPI Number : 1134627383
Entity Type Code : Individual
Provider Name (Legal Business Name) : KACI CARROLL
Provider Business Mailing Address
First Line : 4487 FORBES BLVD # 4485
Second Line :
City : LANHAM
State : MD
Zip : 20706-4354
Country : US
Telephone Number : 301-429-2900
Fax Number :
Provider Business Practice Location Address
First Line : 4487 FORBES BLVD # 4485
Second Line :
City : LANHAM
State : MD
Zip : 20706-4354
Country : US
Telephone Number : 301-429-2900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2018
Last Update Date : 09/09/2022

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Directions to “ KACI CARROLL ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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