Provider Demographics
NPI:1821554940
Name:MCCAULLEY, CLAIRE COURY (RBT)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:COURY
Last Name:MCCAULLEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 GROSVENOR DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-4917
Mailing Address - Country:US
Mailing Address - Phone:585-764-8649
Mailing Address - Fax:
Practice Address - Street 1:3717 GROSVENOR DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-4917
Practice Address - Country:US
Practice Address - Phone:585-764-8649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-19-76192106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician