Provider Demographics
NPI:1457652463
Name:CACCARILE, DENISE (BCBA)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:CACCARILE
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 1:5080 SHOREHAM PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5930
Mailing Address - Country:US
Mailing Address - Phone:858-272-2662
Mailing Address - Fax:858-272-2661
Practice Address - Street 1:5080 SHOREHAM PL
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5930
Practice Address - Country:US
Practice Address - Phone:858-272-2662
Practice Address - Fax:858-272-2661
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-07
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst