Provider Demographics
NPI:1558121764
Name:CARLSEN, DONALD (BCBA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:CARLSEN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FORTIER DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-1106
Mailing Address - Country:US
Mailing Address - Phone:603-973-2053
Mailing Address - Fax:
Practice Address - Street 1:15 FORTIER DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-1106
Practice Address - Country:US
Practice Address - Phone:603-973-2053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-24-72000103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst