Provider Demographics
NPI:1588226674
Name:CARMICAL, MARIE ELOISE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELOISE
Last Name:CARMICAL
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ELOISE
Other - Last Name:PIERSALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6339 ARGYLE FOREST BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6339 ARGYLE FOREST BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6666
Practice Address - Country:US
Practice Address - Phone:640-374-6403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst