Provider Demographics
NPI:1881212413
Name:ZACSH, CAROLYN BARRY (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:BARRY
Last Name:ZACSH
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1610 W FULLERTON AVE UNIT 408
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-9051
Mailing Address - Country:US
Mailing Address - Phone:773-805-6128
Mailing Address - Fax:
Practice Address - Street 1:1422 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-8978
Practice Address - Country:US
Practice Address - Phone:773-630-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12042429103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst