Provider Demographics
NPI:1417518382
Name:GLASSMEYER, CARLY (BCBA)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:GLASSMEYER
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 1:411 HOBRON LN APT 1609
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1213
Mailing Address - Country:US
Mailing Address - Phone:513-382-0209
Mailing Address - Fax:
Practice Address - Street 1:95-732 MAIAKU ST
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2816
Practice Address - Country:US
Practice Address - Phone:808-321-8105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
HIBA-856-0103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician