Provider Demographics
NPI:1942725080
Name:SIMON, CARLA ANN (BCBA)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:ANN
Last Name:SIMON
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 1:3315 JASPER PL
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-3694
Mailing Address - Country:US
Mailing Address - Phone:914-236-9063
Mailing Address - Fax:
Practice Address - Street 1:3904 OLEANDER DR STE 101
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6735
Practice Address - Country:US
Practice Address - Phone:910-313-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5854103K00000X
NC1-17-28990103K00000X
NC311103K00000X
KY288651103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst