Provider Demographics
NPI:1598123556
Name:STEINER, CARLY (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:STEINER
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:BACINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA
Mailing Address - Street 1:1332 MARYLAND ST
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1006
Mailing Address - Country:US
Mailing Address - Phone:248-915-8315
Mailing Address - Fax:
Practice Address - Street 1:1332 MARYLAND ST
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1006
Practice Address - Country:US
Practice Address - Phone:248-915-8315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-15-18447103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst