Provider Demographics
NPI:1578045464
Name:MICHAEL, KARA LOUISE (BCBA)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:LOUISE
Last Name:MICHAEL
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 1:163 CANDLEWOOD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2104
Mailing Address - Country:US
Mailing Address - Phone:203-731-1643
Mailing Address - Fax:
Practice Address - Street 1:163 CANDLEWOOD LAKE RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2104
Practice Address - Country:US
Practice Address - Phone:203-731-1643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst