Provider Demographics
NPI:1467749960
Name:BROCATO, ELLEN B (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:B
Last Name:BROCATO
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-5314
Mailing Address - Country:US
Mailing Address - Phone:318-308-0109
Mailing Address - Fax:
Practice Address - Street 1:3900 STERKX RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3562
Practice Address - Country:US
Practice Address - Phone:318-308-0109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1-14-1915103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst