Provider Demographics
NPI:1093216111
Name:HICKEY, CARALEE TRI-ANN (BCBA)
Entity Type:Individual
Prefix:
First Name:CARALEE
Middle Name:TRI-ANN
Last Name:HICKEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 MACE BLVD.
Mailing Address - Street 2:STE J #114
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6077
Mailing Address - Country:US
Mailing Address - Phone:530-574-0556
Mailing Address - Fax:
Practice Address - Street 1:417 MACE BLVD.
Practice Address - Street 2:STE J #114
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-6077
Practice Address - Country:US
Practice Address - Phone:530-574-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-49090103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst