Provider Demographics
NPI:1821607532
Name:LONG, KARA MICHELLE (M ED, BCBA)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:MICHELLE
Last Name:LONG
Suffix:
Gender:F
Credentials:M ED, BCBA
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:MICHELLE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M ED, BCBA
Mailing Address - Street 1:PO BOX 23183
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92023
Mailing Address - Country:US
Mailing Address - Phone:760-525-9736
Mailing Address - Fax:
Practice Address - Street 1:1650 SPRUCE ST STE 250
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507
Practice Address - Country:US
Practice Address - Phone:760-525-9736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-20-43527103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst