Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | $$$$$$$$$ | NY |
NPI | 1003405473 |
---|---|
Provider Name | Cara Jean Carlo |
First Address | Wantagh, NY 11793-3401 |
Second Address | Wantagh, NY 11793-3401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2021 |
Last Update Date | 11/01/2021 |