Provider Demographics
NPI:1497224190
Name:VACCARELLO, CARLY (BCBA)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:VACCARELLO
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 1:1666 NEBRASKA DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-2915
Mailing Address - Country:US
Mailing Address - Phone:847-636-8330
Mailing Address - Fax:
Practice Address - Street 1:1161 LAKE COOK RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5649
Practice Address - Country:US
Practice Address - Phone:847-498-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst