MEDICARE: CAROLYN R MACMURTRIE 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	1-20-45760	PA

General Provider Information

NPI Number	:	1649874538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN R MACMURTRIE BCBA

Provider Business Mailing Address
First Line	:	542 AMHERST ST STE B
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03063-1016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	999 OLD EAGLE SCHOOL RD
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-1707
Country	:	US
Telephone Number	:	844-528-1222
Fax Number	:

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

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	05/11/2026

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