Provider Demographics
NPI:1164981502
Name:CARR, JACY (BCBA)
Entity Type:Individual
Prefix:
First Name:JACY
Middle Name:
Last Name:CARR
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 1:6115 WOODHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-2541
Mailing Address - Country:US
Mailing Address - Phone:863-808-7790
Mailing Address - Fax:
Practice Address - Street 1:6115 WOODHAVEN DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-2541
Practice Address - Country:US
Practice Address - Phone:863-808-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst