Provider Demographics
NPI:1700388980
Name:ANSON, CARLY (BCBA)
Entity type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:
Last Name:ANSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MRS
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:ANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:505 WINDY KNOLL DR UNIT 323
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-6614
Mailing Address - Country:US
Mailing Address - Phone:240-668-4415
Mailing Address - Fax:240-673-6322
Practice Address - Street 1:1515 RISING RIDGE RD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5383
Practice Address - Country:US
Practice Address - Phone:203-895-8335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA731103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst