Provider Demographics
NPI:1497180251
Name:CARBONE, VINCENT J (EDD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:J
Last Name:CARBONE
Suffix:
Gender:M
Credentials:EDD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 CORPORATE WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2022
Mailing Address - Country:US
Mailing Address - Phone:845-267-0920
Mailing Address - Fax:
Practice Address - Street 1:614 CORPORATE WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2022
Practice Address - Country:US
Practice Address - Phone:845-267-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYBCBA-D 1-00-0232103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBCBA-D 1-00-0232OtherBACB