Provider Demographics
NPI:1740017243
Name:ABOGADO, CARLOTTA GABRIELLE (BCBA)
Entity type:Individual
Prefix:
First Name:CARLOTTA
Middle Name:GABRIELLE
Last Name:ABOGADO
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 1:6013 FOREST VIEW RD APT 1F
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3367
Mailing Address - Country:US
Mailing Address - Phone:773-915-3519
Mailing Address - Fax:
Practice Address - Street 1:9570 W 159TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5698
Practice Address - Country:US
Practice Address - Phone:224-315-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBACB460737103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst