Provider Demographics
NPI:1326600446
Name:BRONER, CAROLYN K (BCBA)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:K
Last Name:BRONER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2339 MEADOW PEAK PT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4366
Mailing Address - Country:US
Mailing Address - Phone:313-320-4530
Mailing Address - Fax:
Practice Address - Street 1:2930 HORIZON PARK DR STE D
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7252
Practice Address - Country:US
Practice Address - Phone:770-462-8550
Practice Address - Fax:470-322-4355
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-29
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-36380103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst