MEDICARE: DENISE CACCARILE BCBA

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

General Provider Information

NPI Number	:	1457652463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE CACCARILE BCBA

Provider Business Mailing Address
First Line	:	5080 SHOREHAM PL STE 103
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-5931
Country	:	US
Telephone Number	:	858-272-2662
Fax Number	:	858-272-2661

Provider Business Practice Location Address
First Line	:	1002 N IMPERIAL AVE
Second Line	:	SUITE 2-280
City	:	EL CENTRO
State	:	CA
Zip	:	92243-1738
Country	:	US
Telephone Number	:	858-272-2662
Fax Number	:	858-272-2661

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

Provider Enumeration Date	:	11/07/2010
Last Update Date	:	02/27/2026

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