Provider Demographics
NPI:1689919367
Name:LYBRAND, CAROLINE (BCBA)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:LYBRAND
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 1:204 WILSON ST.
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379
Mailing Address - Country:US
Mailing Address - Phone:321-446-6888
Mailing Address - Fax:
Practice Address - Street 1:204 WILSON ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-1646
Practice Address - Country:US
Practice Address - Phone:321-446-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-13-13357103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst