Provider Demographics
NPI:1649942277
Name:CARRASCO, TAYLOR (BCBA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:CARRASCO
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 1:220 GERRY DR
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-1129
Mailing Address - Country:US
Mailing Address - Phone:847-553-4009
Mailing Address - Fax:
Practice Address - Street 1:220 GERRY DR
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1129
Practice Address - Country:US
Practice Address - Phone:847-553-4009
Practice Address - Fax:847-498-5438
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2024-08-27
Deactivation Date:2024-07-18
Deactivation Code:
Reactivation Date:2024-07-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst