MEDICARE: ISAMAR CARABALLO

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
1	103K00000X	Behavior Analyst	LBA00534	RI

General Provider Information

NPI Number	:	1275480287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAMAR CARABALLO

Provider Business Mailing Address
First Line	:	164 LENOX AVE
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02907-2104
Country	:	US
Telephone Number	:	401-692-3003
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 TOLL GATE RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-2717
Country	:	US
Telephone Number	:	401-692-3003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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Directions to “ ISAMAR CARABALLO ” Practice Location

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