Provider Demographics
NPI:1730514597
Name:VINCENT J CARBONE, ED.D., BCBA, LLC DBA CARBONE CLINIC
Entity type:Organization
Organization Name:VINCENT J CARBONE, ED.D., BCBA, LLC DBA CARBONE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CARBONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-267-0920
Mailing Address - Street 1:614 CORPORATE WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2022
Mailing Address - Country:US
Mailing Address - Phone:845-267-0920
Mailing Address - Fax:
Practice Address - Street 1:614 CORPORATE WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2022
Practice Address - Country:US
Practice Address - Phone:845-267-0920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYBCBA-D 1-00-0232103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBCBA-D 1-00-0232OtherBACB