Provider Demographics
NPI:1528216876
Name:CALARCO, KATHERINE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:CALARCO
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:CALARCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4204A ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2300
Mailing Address - Country:US
Mailing Address - Phone:619-786-0074
Mailing Address - Fax:619-202-7741
Practice Address - Street 1:4204A ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-2300
Practice Address - Country:US
Practice Address - Phone:619-786-0074
Practice Address - Fax:619-202-7741
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-05-2509174400000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist