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NPI Code Detail

MEDICARE: CARISSA CAREY M.S.ED., BCBA, LBA

MEDICARE: CARISSA CAREY M.S.ED., BCBA, LBA
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
1103K00000XBehavior Analyst1165CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11165OTHERCTCT LICENSE
21-21-48139OTHERBACB

General Provider Information

NPI Number : 1659037042
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARISSA CAREY M.S.ED., BCBA, LBA
Provider Business Mailing Address
First Line : 373 WARD ST
Second Line :
City : WALLINGFORD
State : CT
Zip : 06492-4614
Country : US
Telephone Number : 203-506-3111
Fax Number :
Provider Business Practice Location Address
First Line : 373 WARD ST
Second Line :
City : WALLINGFORD
State : CT
Zip : 06492-4614
Country : US
Telephone Number : 203-506-3111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2021
Last Update Date : 11/10/2021

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